wmj_4_2020_WEB

General Assembly Report
vol. 66
Medical
World
Journal
Official Journal of The World Medical Association, Inc.
ISSN 2256-0580
Nr. 4, December 2020
Contents
Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Valedictory Speech by the WMA President, Dr. Miguel Jorge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Presidential Inaugural address by David O. Barbe, MD MHA President . . . . . . . . . . . . . . . . . . . . . . . . . 3
WMA 2020 General Assembly Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
WMA Declaration of Cordoba on Patient-Physician Relationship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
WMA Declaration of Oslo on Social Determinants of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
WMA Declaration of Ottawa on Child Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
WMA Declaration on Pseudoscience and Pseudotherapies in the Field of Health . . . . . . . . . . . . . . . . . 21
WMA Resolution in Support of an International Day of the Medical Profession . . . . . . . . . . . . . . . . . . 22
WMA Resolution in Support of Dr. Serdar Küni . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
WMA Resolution in Support to theTurkish Medical Association. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
WMA Resolution on Equitable Global Distribution of Covid-19 Vaccine. . . . . . . . . . . . . . . . . . . . . . . . 24
WMA Resolution on Human Rights Violations Against Uighur People in China . . . . . . . . . . . . . . . . . 25
WMA Resolution on Protecting the Future Generation’s Right to Live in a Healthy Environment. . . 26
WMA Resolution on the Access to Adequate PainTreatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
WMA Resolution on the Responsibility of Physicians in the Documentation and Denunciation
of Acts ofTorture or Cruel or Inhuman or DegradingTreatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
WMA Resolution Regarding the Medical Profession and Covid-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
WMA Statement Concerning the Relationship Between Physicians and Commercial Enterprises . . . 31
WMA Statement on Human Genome Editing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
WMA Statement on Hypertension and Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
WMA Statement on Measures for the Prevention and Fight AgainstTransplant-Related Crimes . . . 36
WMA Statement on Stem Cell Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
WMA Statement on Violence Against Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
The Declaration of Geneva: Conscience, Dignity and Good Medical Practice. . . . . . . . . . . . . . . . . . . . . 41
The World Health Organization Fifty-fifth Expert Committee on Specifications for Pharmaceutical
Preparations Special Session with non-State Actors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Official Letter to the World Medical Journal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
Editor in Chief
Dr. Pēteris Apinis, Latvian Medical Association, Skolas iela 3, Riga, Latvia
editorin-chief@wma.net
Co-Editor
Prof. Dr. med. Elmar Doppelfeld, Deutscher Ärzte-Verlag, Dieselstr. 2, D-50859 Köln, Germany
Assistant Editor
Maira Sudraba, Velta Pozņaka; lma@arstubiedriba.lv
Journal design by
Pēteris Gricenko
Layout and Artwork
The Latvian Medical Publisher, “Medicīnas apgāds”, President Dr. Maija Šetlere, Skolas street 3, Riga, Latvia
Publisher
Medicīnas apgāds, Ltd
Skolas street 3, Riga, Latvia.
ISSN: 0049-8122
Dr. David BARBE
WMA President
American Medical Association
AMA Plaza, 330 N. Wabash, Suite
39300 60611-5885 Chicago, Illinois
United States
Dr. Otmar KLOIBER
Secretary General
World Medical Association
13 chemin du Levant
01212 Ferney-Voltaire
France
Dr. Osahon ENABULELE
WMA Chairperson of the Socio-
Medical Affairs Committee
Nigerian Medical Association
8 Benghazi Street, Off Addis Ababa
Crescent Wuse Zone 4, FCT,
PO Box 8829 Wuse
Abuja
Nigeria
Dr. Heidi STENSMYREN
WMA President-Elect
Swedish Medical Association
(Villagatan 5) P.O. Box 5610
SE-114 86 Stockholm
Sweden
Dr. Kenji MATSUBARA
WMA Vice-Chairperson of Council
Japan Medical Association
113-8621 Bunkyo-ku,Tokyo
Japan
Dr. Joseph HEYMAN
WMA Chairperson of the Associate
Members
163 Middle Street
West Newbury, Massachusetts 01985
United States
Dr. Miguel Roberto JORGE
WMA Immediate Past-President
Brazilian Medical Association
Rua-Sao Carlos do Pinhal 324,
CEP-01333-903 Sao Paulo-SP
Brazil
Dr. Ravindra Sitaram
WANKHEDKAR
WMA Treasurer
Indian Medical Association
Indraprastha Marg 110 002
New Delhi
India
Prof. Dr. Frank Ulrich
MONTGOMERY
Chairperson of Council
Bundesärztekammer
Herbert-Lewin-Platz 1 (Wegelystrasse)
10623 Berlin
Germany
Dr. Jung Yul PARK
WMA Chairperson of the Finance
and Planning Committee
Korean Medical Association
Samgu B/D 7F 8F 40 Cheongpa-ro,
Yongsan-gu
04373 Seoul
Korea, Rep.
World Medical Association Officers, Chairpersons and Officials
Official Journal of The World Medical Association
Opinions expressed in this journal – especially those in authored contributions – do not necessarily reflect WMA policy or positions
www.wma.net
1
Editorial
Editorial
Dear colleagues!
How I am missing you!
The meetings of the WMA – the Assembly General and the Coun-
cil Session – are like gulps of fresh water allowing to be refreshed
and setting new dimensions. Meetings with colleagues from other
countries, particularly – the leaders of National Medical Associa-
tions,make it possible not only to learn and obtain new information,
but also to look at things from a different perspective.The WMA is
an organisation that combines the ordinary with the different – our
likeness as professionals and differences as representatives of our
cultural environment.  The WMA Assembly General in Cordoba
was successful; there was versatility of opinion and drawing up of
serious documents. And yet – this meeting lacked human contact
that allows you to shake hands and look into the eyes of the other
person, get a colleague’s smile and return it.
I believe that colleagues all over the world are on the verge of a
new challenge. Vaccines against Covid-19 have been produced and
vaccination has started in different countries. Still, we all have our
doubts: whether there has been sufficient vaccine research, whether
it will be safe,whether it will provide sufficient immunity,or wheth-
er we will manage to stop the pandemic with this vaccine.
Herd immunity will require 60–80% of the world population to be
vaccinated against Covid-19. Vaccination is treated differently in
different countries. There are quite a large number of people who
are against the new vaccine as well as those who have not decided
whether to vaccinate or not.
At least in 2021, there will not be enough vaccines for everyone. It
should be quite strongly noted that the people to receive vaccination
first are those who are most vulnerable to the disease – the elderly,
with a number of cardiovascular, endocrinological or oncological
diseases, people with reduced immunity, very slow-moving and
adipose patients, patients with lung diseases, etc. And there would
be no grounds for initially vaccinating those who have already had
the disease with or without symptoms or already had antibodies for
Covid-19. And it should be remembered that there are also among
doctors elderly people with reduced immunity, with multiple ill-
nesses, and they would deserve to be vaccinated first.
The other thing we all need to agree in principle is: a vaccine is a
biological drug, and medication is prescribed by doctors, not offi-
cials nor politicians.Today, politicians from many countries want to
be doctors and rescuers of humanity.
Moreover,we live like in war-time conditions.There are more or less
stringent restrictions in all countries of the world. There are differ-
ent business closures and there are considerably fewer opportunities
to travel as well as to meet doctors from other countries. However,
there is a book written a century ago and it describes the current
feelings incredibly well.And from this book I would like to send you
the message: “Meet me at 6 o’clock after the war.”It is a quote from
one of the greatest books provoked by World War I – it is The Fate
of the Good Soldier Švejk which is an unfinished satirical dark comedy
novel by the Czech writer Jaroslav Hašek, published in 1921–1923,
about a good-humoured, simple-minded middle-aged man who is
enthusiastic to serve Austria-Hungary in World War I.
Dr. med. h. c. Peteris Apinis,
Editor-in-Chief of the World Medical Journal
BACK TO CONTENTS
2
General Assembly Report
Dear Colleagues and Friends, Ladies and
Gentlemen,
Our tradition requests that the World Med-
ical Association (WMA) outgoing Presi-
dent, deliver a so-called Valedictory Speech
at this Ceremonial Session of our General
Assembly. Accordingly to different diction-
aries, valedictory is related to “say goodbye”
or “a statement of farewell”. As a psychia-
trist, I am very much prone to always try
to be in contact with feelings and emotions,
mine and from those people to whom I am
in relationship.Therefore, I hope to not just
shortly report what I have done during my
Presidential year but also how I felt others
and myself during the period ending today.
I can guarantee to you all, that it was quite
different from any other Presidential term.
I started my Presidential term just after our
General Assembly in Tbilisi, Georgia, going
from there directly to Tokyo, Japan, for the
Commemorative Ceremony of the 72nd
An-
niversary of the Japan Medical Association
(JMA) on the 1st
of November 2019. JMA
has carried out during its existence not just
many important activities on behalf of the
Japanese people but was and continue to be
an outstanding member of the WMA.
In the beginning of December 2019,Taiwan
Medical Association,one another important
member of the WMA, has organized an In-
ternational Symposium on Primary Health
Care, in Taipei, where I had the opportu-
nity to speak about the theme I choose to
highlight during my Presidential term – the
importance of the doctor-patient relation-
ship – which is even more important in the
context of primary health care.
From Taipei, I went directly to Muscat, in
the Emirate of Oman,for the World Health
Organization (WHO) Global Meeting on
Non Communicable Diseases (NCDs) and
Mental Health. I have spoken in two differ-
ent panels, emphasizing the contributions
WMA and some of its National Medical
Associations (NMAs) have been develop-
ing, sometimes in collaboration with other
health professional organizations, to better
prepare those responsible for assisting pa-
tients with NCDs and their mental health.
Not exactly from my role as WMA Presi-
dent but as a member of the WMA Work-
group which is revising the International
Code of Medical Ethics (ICoME), I have
organized in early March of the current year,
in São Paulo,a regional conference to discuss
different medical ethics issues of interest to
Latin America countries and also to Portu-
gal and Spain, our “country brothers” from
Europe.There were 50 people from nine dif-
ferent countries discussing different themes
of interest to the revision of the ICoME.
Well … then … the coronavirus pandemic
impacted us. All meetings that WMA and
its NMAs were planning and/or were invit-
ed to participate, were cancelled, postponed
or changed to occur through Internet ways
of communication. Many countries, all over
the world, started to face lockdowns in dif-
ferent regions and cities, and a vast majority
of international flights was cancelled. As we
say … the world was placed upside down!
Moreover, we have to experience months of
quarantine at home.
With such a change in the way we live and
work, we were pushed to be more resilient
and creative. I  was confined in my apart-
ment and did not see even my daughter
and grandsons for weeks in a row. Initially,
I was thinking that it would be a time to do
all those things we never have time to do
before but … I have never worked so tire-
less. My duties as President of the World
Medical Association, Chair of the Research
Ethics Committee of my University, and
Director of the Brazilian Medical Associa-
tion, left me not much time to relax.
You can have an idea of my doings just read-
ing my Presidential report to the WMA
Council, encompassing at least 24 activities
during the pandemic: live, recorded or writ-
ten interviews, and presentations. I  spoke
about many topics related to the pandemic
such as the role of the WMA and other
medical organizations, physicians and pa-
tients’safety, ethics, climate change, solidar-
ity, and different issues on mental health –
of common people and of physicians and
other health personnel at the frontline care.
I am sure it was difficult times to all, much
more to some than to others. At the begin-
ning,we had very little knowledge about the
virus characteristics and particularly about
the COVID19 disease: no vaccine and no
specific treatment available; high trans-
mission and a considerable lethality; great
concern of a collapse of health services.
Valedictory Speech by the WMA President, Dr. Miguel Jorge.
WMA General Assembly Cordoba (Virtual), October, 2020
Miguel R. Jorge
BACK TO CONTENTS
3
General Assembly Report
Therefore, most people were experienc-
ing anxiety and fears, including physicians
who – at many and different places – where
also experiencing a work overload and a lack
of enough and adequate personal protective
equipment. And, in times of many discred-
iting science and spreading fake news, with
a major contribution even from people in
position of command – like the President
of my country and of the country of our
next WMA President – I believe that much
more people were inadequately exposed to
the virus, were infected and many died. At
the time when I am writing this speech –
the middle of October – WHO is count-
ing more than 38 million of cases and more
than one million of deaths. Those numbers
are considered very much under what hap-
pened in reality and the pandemic is still
going on everywhere.
During the pandemic, I have listened that
we all were at the same ship.It could be true
but lets remember that many ships have
passengers in the first, second and third
classes. Our world is an unequal world and
for many people the recommendation to
stay at home and keep physical distance one
from another sounds as a joke. I am not just
referring to people who lives in slums or as
homeless in my country, Brazil, but also to –
accordingly to the World Bank data – al-
most half of the world’s population who still
struggles to meet basic needs or to almost
10% of the world’s population who lives in
extreme poverty.
COVID19 has directly affected physical
and mental health of millions, and indirect-
ly affected socially and economically bil-
lions of people. Poverty and inequality are
growing and people will continue, for many
years, to suffer from fears, grief, anxiety, de-
pression, loneliness, uncertainties, economic
loss, and social disruption. Now, more than
ever, universal health coverage – including
mental health care – would be the best way
to provide health for all.
It is time to start thinking about the future,
at short, medium and long-term. It was
clear that the WHO and governments were
not well prepared to deal with emergencies
such as those related to pandemics caused
by infectious diseases or natural disasters.
Health does not have enough priority for
many of those who lead our countries and
usually is insufficiently funded. In many
countries, corruption also contributes to di-
vert part of the budget allocated to health.It
was possible to see politicians trying to save
their mandates and not human lives, and
even the WHO was accused to not act as
required in the beginning of the pandemic
because of political influences. It was also
possible to observe in some regions, a lack
of health services, hospital infrastructure
and health personnel. The supply chain of
medical equipment relies very much in few
or sometimes just one source. All these fac-
tors will need to be realistic faced and fixed,
and they will not be unless the health stake-
holders take initiatives to raise awareness
and mobilize our communities to push their
governments in the desired and needed way.
The diagnosis exists.It needs to be complet-
ed and then to adopt a treatment plan to
what were harmed and preventive measures
to not have further damages.
I am deeply grateful for your continuous
support and hope to see you all soon again.
Thank you!
Presidential Inaugural address by David O. Barbe, MD MHA
President. WMA General Assembly Cordoba (Virtual), October, 2020
Thank you, Dr. Jorge for your excellent ser-
vice as our president this past year. Thank
you to this Assembly for the confidence
you have placed in me. It is an honor and
very humbling to serve as your president
for the coming year. I look forward to lead-
ing the largest and most influential inter-
national physician organization on your
behalf.
Before I begin my formal remarks, I must
express my gratitude to the AMA Board of
Trustees and the AMA delegation to the
WMA for the confidence they showed by
supporting my candidacy for WMA presi-
dent. Thank you. Also, a special thank you
to Dr. Ardis D Hoven who was Chair of
Council during my time as a delegate to
the WMA and a wonderful mentor for me
as I became familiar with the policies and
processes at the WMA. Thank you, Ardis.
I would not be in this position today if it
were not for my good friend, former AMA
President and delegate to the WMA, Dr.
Andrew Gurman. From the very beginning
Andy encouraged, supported, and mentored
me as a WMA delegate and then as a can-
didate for WMA president. Andy, I cannot
thank you enough for your friendship and
your encouragement.
And last, but certainly not least, my wife,
Debbie. Without her love and support
and the sacrifices she has made, I would
not have been able to serve our profession
at state, national and now international
levels. I could not have asked for a better
wife, partner, and friend. Thank you, Deb-
bie! Colleagues – friends – we find ourselves
in an unusually complex and difficult health
care environment. Just look at our agenda
at this meeting. Ethical challenges, clinical
challenges, protecting our profession, and
assuring quality care for patients. If this
were not enough, it is even more difficult
due to the coronavirus pandemic.
BACK TO CONTENTS
4
General Assembly Report
It is in times like these that our fellow phy-
sicians and our patients need our leadership
more than ever. We need strong physician
organizations at every level: the WMA, our
NMAs and state and local medical societ-
ies. It takes collaboration and cooperation
between our organizations and our encour-
agement of one another to address these
challenges. We must function as a virtual
team comprised of our professional organi-
zations and our physician members.
In one of my speeches to the AMA House
of Delegates, I emphasized the importance
of “teamwork”. Let me quote from that
speech:
“Winning teams recognize that the greatest
success comes not from the effort of one or
more individuals but from a team effort.One
of the greatest individual talents in American
baseball, “Babe” Ruth put it this way, “The
way a team plays as a whole determines its
success. You may have the greatest bunch of
individual stars in the world,but if they don’t
play together, the (team) won’t be worth a
dime.””
Each of you in this virtual meeting to-
day is a strong individual leader. And we
need strong individual leaders. But more
than that, we must each be committed to
the team. Committed to the WMA’s mis-
sion “to serve humanity by endeavoring
to achieve the highest international stan-
dards in Medical Education, Medical Sci-
ence, Medical Art and Medical Ethics, and
Health Care for all people in the world.”
This is an ambitious goal, but we can make
significant advances in these important ar-
eas if we work together as a WMA team.
Let me briefly touch on a few issues that
I believe are most important for the WMA.
I will start with COVID-19. Who could
have imagined a pandemic of this mag-
nitude that would not only threaten the
health of our patients but place our physi-
cians and nurses in danger and cripple our
economies? However, that is what we are
facing, and that is what we must address.
We must continue to advocate for adequate
personal protective equipment, appropri-
ate facilities and medical equipment, and
adequate support staff. We must work with
public health officials to pursue policies that
reduce the frequency and severity of disease
while at the same time allow for an orderly
and safe conduct of business and education.
We must continue to let the science lead us
and be vocal advocates for evidence-based
treatment and safe and effective vaccines.
A second area that is critically important is
the WMA’s unwavering advocacy in medi-
cal ethics. It was a key reason for the found-
ing of the WMA in 1947 and it remains as
important and relevant now as it was then.
The multiple WMA declarations and state-
ments that address medical ethics must be
living, evolving documents that meet the
changing needs of patients, physicians and
society while at the same time preserving
the essence of who we are as physicians and
affirming our responsibilities to patients
and society. This may be one of our most
difficult challenges because medical ethics
rests squarely on our shoulders. We cannot
delegate it or relegate it to others. Although
we must facilitate discussions among a
broad group of stakeholders, the ultimate
decision on what our profession stands for
is ours alone to make. Closely related to our
position on ethical issues is our dedication
to professionalism. As physicians, we must
hold ourselves to the highest standards. We
must stay committed to the core principles
of the patient-physician relationship. We
must speak out and seek remedies to address
violence against patients and physicians.We
must point out the inhumanity of societal
or governmental actions that target ethnic
or religious groups or that use chemical,
biological or nuclear weapons against oth-
ers. I am proud of our WMA declarations
and statements on these topics, and I am
encouraged that we are refining these poli-
cies as we identify unethical and inhumane
practices around the world.
One final area that needs our continued at-
tention is our primary role as physicians in
delivering high-quality, medical care for all.
We must continue to address the inequities
in health and healthcare in our populations.
At the same time, we are still battling a rise
in chronic disease worldwide. In fact, the
­
COVID-19 pandemic has made the inter-
section of health inequities and chronic dis-
ease even more apparent.Those already expe-
riencing health inequity are often those with
chronic diseases who are also at increased
risk for COVID-19. Chronic diseases such
as cardiovascular disease, diabetes, and hy-
pertension occur with greater incidence in
populations of color, Asians and those in
lower socio-economic sectors. We can ad-
dress both health inequities and chronic
disease at this meeting. We can improve our
policies on health inequities by adopting the
major revisions to the Declaration of Oslo,
and we can expand our policies on chronic
disease by adopting the WMA statement
on hypertension and cardiovascular disease.
These are just a few examples of where the
WMA and our NMAs must lead the na-
tional and international discussions on issues
that will benefit our patients, our physicians
and society. I  look forward to working on
your behalf during my term as president to
David O. Barbe
BACK TO CONTENTS
5
General Assembly Report
The WMA’s 71st
annual General Assem-
bly was due to be held in Cordoba, Spain
to mark the 100th
anniversary of the Span-
ish Medical Association. But regrettably,
because of Covid-19, the Assembly had to
be held online. From October 26 to 30, the
WMA organised a five-day virtual confer-
ence, with more than 100 delegates from
almost 60 national medical associations
registering for the committee meetings, and
the Council and Assembly sessions.
Monday October 26
Council
The Secretary General, Dr. Otmar Kloiber,
welcomed participants to the meeting.
The Chair of Council, Dr. Frank Ulrich
Montgomery, said it had been decided to
postpone until 2021 the scientific session
due to be held in Cordoba,.
Vice Chair of Council
Dr. Kenji Matsubara (Japan), a Council
member for the past six years, was elected
unopposed as Vice Chair of Council.
President’s Report
The President, Dr. Miguel Jorge (Brazil),
reported on his activities since his inau-
guration a year ago. He reminded the
meeting that his theme had been the im-
portance of the physician-patient relation-
ship. Among the meetings he had attend-
ed were the 72nd
Anniversary of the Japan
Medical Association, the 7th
International
Congress of Person Centered Medicine
and the International Symposium on Pri-
mary Health Care. He said it had been a
very busy, if unusual year, with the out-
break of the pandemic. He was now look-
ing forward to his term as Immediate Past
President.
Secretary General’s Report
Dr. Kloiber referred the meeting to the
lengthy written report to Council about the
work of the secretariat.
He said that there might be a need to dis-
cuss Covid-19 in more depth than was pos-
sible at this meeting, and it had been sug-
gested that a separate conference might be
held next year.
The Chinese Medical Association proposed
an amendment to the report, deleting the
section relating to the WMA press release
denouncing a reported breakdown of medi-
cal care and
humanitarian assistance for protesters in
Hong Kong. The Chinese delegate said
these reports of physicians and other medi-
cal staff being arrested, and injured students
and protesters being denied medical assis-
tance, were not true.
But in the absence of a seconder,the amend-
ment fell.
Chair’s Report
Dr. Montgomery, in his written report, re-
ferred to his visits to Hong Kong, Taipei
and Kolkata in India. Then SARS-CoV2
engulfed the world. Countries and conti-
nents followed different strategies to fight
the pandemic virus, ranging from efforts to
attain ‘herd immunity’ quickly by allowing
people to maintain contacts and exposure
to the virus, to total shut-down scenarios.
He said the outcome of these various strate-
gies was going to be the subject of scientific
scrutiny for a long time to come.
Emergency Resolutions
Four emergency motions were submitted to
the Council for consideration.
Medical Profession and Covid
The Spanish Medical Association, support-
ed by the medical associations of France,
Uruguay, Brazil, South Africa, South Ko-
rea and Australia, introduced an emergency
resolution entitled ‘The Medical Profession
and COVID-19’. The purpose of the reso-
lution was to address the problems facing
promote the new policies from this meeting
and our extensive existing policy.
I started with a quote by Babe Ruth on the
importance of working together as a team.
He made another observation that I think
is equally important.
He said, “It’s hard to beat a person who
never gives up.” Your WMA leadership will
never give up in our efforts to advance our
policies and achieve our common goals.
However, we are depending on each of you
as part of the WMA team to use what we
do here at the WMA to advocate on behalf
of patients and physicians to “achieve the
highest international standards” in medi-
cine “and Health Care for all people in the
world.”
Thank you.
WMA 2020 General Assembly Report
Cordoba (Virtual), October 26–30, 2020
Nigel Duncan
BACK TO CONTENTS
6
General Assembly Report
physicians, thousands of whom were losing
their lives practicing their profession and
fulfilling their ethical duties. The resolution
called for sufficient provision of equipment
and personal protection material, and urged
governments to adopt a multilateral and co-
ordinated approach on a global scale of the
crisis to promote equality in interventions,
access to health services, treatments and
future vaccines. It demanded the strength-
ening of health care systems and for SARS
CoV-2 infection to be recognized as an oc-
cupational disease with the medical profes-
sion declared a ‘profession at risk’. Finally,
it called for zero tolerance towards violence
in healthcare settings, following reports of
violence against physicians.
The Council agreed that the resolution be
forwarded to the Assembly for adoption.
International Day of the Medical Profession
The Spanish delegate presented a second
resolution proposing an International Day
of the Medical Profession on October 30 as
a tribute to the commitment of physicians
during the pandemic. Such a day would
recognise those physicians who had lost
their lives during Covid-19 and those who
continued to combat the pandemic. A sug-
gestion that health care workers should be
included was not supported.
The resolution was approved for forwarding
to the Assembly for adoption.
Turkish Medical Association
The third resolution was proposed by the
Turkish Medical Association, Resolution in
support to the Turkish Medical Association.
This expressed deep concern at the recent
Turkish Government announcement to dis-
mantle the Turkish Medical Association as
a national professional organization, alleg-
edly to ‘protect patients and the profession
from terrorists’. The delegate from Turkey
said the reference to the physician members
of the Turkish Medical Association as ter-
rorists constituted a grave defamation and
an insult to the entire profession. He called
for the protection of the Turkish Medical
Association as a national independent asso-
ciation and main representative of all physi-
cians in the country.
After several speakers voiced their support
for the resolution, the Council agreed that
it should be forwarded to the Assembly for
adoption.
Equitable Vaccines
A fourth emergency resolution on equitable
global distribution of COVID-19 vaccine
was proposed by the German Medical As-
sociation. This stated that given the limits
on vaccine production capacity, it was es-
sential to advocate for equitable worldwide
procurement and distribution. The resolu-
tion also declared that all clinical trials,
including those on accelerated schedules,
must adhere to the ethical principles out-
lined in the Declaration of Helsinki.Finally,
it stressed the need to build public trust in
the face of disinformation.
The resolution was approved for forwarding
to the Assembly for adoption.
Finance and Planning Committee
Dr. Jung Yul Park (Korea) took the chair
and called the committee to order.
Financial Statement
The committee considered the Audited Fi-
nancial Statement for 2019. The Treasurer,
Dr Ravindra Sitaram Wankhedkar (India),
said that the Statement reflected the WMA’s
sound financial situation with a surplus.
The committee recommended that the
Statement be approved by the Council and
forwarded to the General Assembly for
adoption
WMA Budget
The committee considered the proposed
Budget for 2021 vs. Actual 2019 Expendi-
tures
The Financial Advisor reported that the
budget was calculated on the basis of ex-
penses in a normal financial year and had
not yet taken into account any potential
implications of the Covid-19 pandemic,
including a potential reduction in expenses
if one or both meetings needed to be held
on a virtual basis. The budget would be ad-
justed in March 2021 and a report would
be made at the next Finance Committee in
April 2021.
The committee recommended that the Bud-
get be approved by the Council and forward-
ed to the General Assembly for adoption.
Membership Dues Payments and Arrears
A report on Membership Dues Payments
for 2020 was introduced.The meeting heard
from the Financial Adviser on the situation
relating to membership arrears and it was
agreed that the document would be forward-
ed to the General Assembly for information.
The committee considered a proposal to
postpone a 2.5 per cent increase in mem-
bership dues scheduled for 2021.
It was agreed to recommend that the Coun-
cil approve the postponement until the in-
crease became necessary and forward this to
the General Assembly for approval.
WMA Strategic Plan
The committee received a report on the
WMA Strategic Plan. The Secretary Gen-
eral said that the four strategic areas of the
Plan, medical ethics, Universal Health Cov-
erage, human rights and health and opera-
tional capacity had all been deeply affected
by the Covid-19 pandemic. Working pro-
cedures, cooperation, advocacy and outreach
had changed considerably, with workgroups
and other discussions having to be held on-
line. He said the pandemic had once more
underlined the need for Universal Health
Coverage, especially well functioning prima-
ry care structures.In many parts of the globe,
there had been a substantial lack of pandem-
ic preparedness in both resource-rich and
resource-poor countries. This had demon-
strated once more that emergency prepared-
ness must be a vital part of Universal Health
Coverage. Dr Kloiber said the Plan was still
valid and no change was needed.
The report was received.
WMA Statutory Meetings
The committee considered dates for meet-
ings in 2024, two invitations for hosting
BACK TO CONTENTS
7
General Assembly Report
meetings in 2024, 2025 and 2026, and the
theme of Scientific Session at the General
Assembly in 2021.
The Secretary General reported that invita-
tions had been received from the Finnish
Medical Association to host the 2024 Gen-
eral Assembly in Helsinki to mark the 60th
anniversary of the Declaration of Helsinki,
and from the Pakistan Medical Association
to hold meetings in Karachi.
The committee agreed that a decision on
Karachi should be postponed until further
information on security and travel was
available.
The meeting agreed to recommend to the
Assembly that the 226th
Council session be
held from 18-20 April 2024 at a venue to be
decided and that the 75th
General Assembly
be held in Helsinki from 2-5 October 2024.
The Chair, on behalf of the Korean Medi-
cal Association as host of the next Coun-
cil Session in April 2021, reported that the
KMA would communicate with the WMA
Secretariat in early January 2021 to deter-
mine whether the situation would allow an
in-person meeting in Seoul in April.
Scientific Session 2021
It was proposed that the theme for the
Scientific Session at the 2021 General As-
sembly in London be the global response
to antimicrobial resistance in the context of
COVID19.
The British Medical Association said that
the effort to prevent the development and
spread of AMR was reaching a critical
point, and that the global response to the
Covid-19 pandemic had important impli-
cations for tackling antimicrobial resistance.
AMR infections were estimated to cause
700,000 deaths each year globally and were
predicted to rise to 10 million by 2050 if no
action was taken. The rise of AMR would
also lead to people suffering for longer, as
infections became more difficult to treat.
Challenges in addressing AMR, such as
lack of access to clean water and sanitation,
poor infection and disease prevention and
control in health care facilities, farms and
communities and poor access to medicines
and vaccines, had been exposed during the
pandemic.
Covid-19 provided an opportunity to rein-
force key actions which addressed the rise of
AMR.As the world saw the consequences of
not having treatments for infectious disease,
a renewed focus on optimising the use of
antibiotics was vital.The pandemic response
had shown the importance of infection con-
trol and prevention, and the need to develop
accurate diagnostics. It had also confirmed
that the environment, in which humans and
animals interacted, had an impact on health
outcomes, illustrating the need to take glob-
al action through a One-Health approach.
The handling of future pandemics would
need all actions aimed at slowing down the
development of AMR to be firmly in place.
The committee approved the theme for the
Scientific Session.
Membership
Two applications for constituent member-
ship were received from the Círculo Para-
guayo de Médicos, Paraguay and for the
return of The Royal Dutch Medical Asso-
ciation.
The committee recommended that the ap-
plications be sent to Council for adoption
by the Assembly.
Associate Members
Dr. Joe Heyman, Chair of the Associate
Members, tabled a written report, detail-
ing the webinars organised and planned by
the group. The report referred to the work
of three groups within the Associate Mem-
bership, the Junior Doctors Network, the
Past Presidents and Chairs Network, and
the direct members. Consideration had
been given to the idea of a survey to find
out what associate members wanted out of
the WMA and ways to improve network-
ing among the three parts of the group. A
steering committee had been established
and had already met.
The Finance Committee received this re-
port,as well as reports from the Junior Doc-
tors Network and the Past Presidents and
Chairs of Council Network.
Bylaws
Proposed amendments to the WMA Bylaws
were considered.The first related to voting in
the General Assembly,adding the paragraph:
‘The votes scored by each candidate in the
election shall be made known to delegates
at the General Assembly, immediately after
conclusion of counting of votes’.
The committee recommended that the pro-
posed amendment be circulated to the con-
stituent members for comments.
A second amendment was proposed to en-
sure better representation and enhanced
participation from underrepresented re-
gions by increasing the number of Council
seats. After a lengthy debate on the alloca-
tion of seats, the committee again recom-
mended that the proposed amendment be
circulated to the constituent members for
comments.
World Medical Journal
The editor reported that the Journal had
reported from countries around the world
on how they were dealing with Covid-19.
Three editions of the Journal had been pro-
duced this year with a fourth imminent. He
thanked all authors and said they were the
strength and brains of the Journal.
Public Relations
The Committee received a report on the
extensive publicity that the WMA had
received during the Covid-19 pandemic.
A number of press releases had been issued
on support for front line health personnel,
insufficient personal protection, condemna-
tion of assaults on physicians and continu-
ing support for funding the WHO. Numer-
ous interviews had been given by the Chair
of Council and other WMA leaders, result-
ing in the WMA achieving an extremely
high global profile for much of the year.
Tuesday October 27
Socio-Medical Affairs Committee
Dr. Osahon Enabulele (Nigeria) took the
chair and called the committee to order.
BACK TO CONTENTS
8
General Assembly Report
Health and Environment
The committee heard a report about the most
recent meeting of the Environment Cau-
cus. Among the issues discussed were the
#HealthyRecovery initiative launched by the
WHO-Civil SocietyWorking Group to ­Advance
Action on Climate Change and Health, and the
global survey on climate change launched by
the Global Climate and Health Alliance and
George Mason University’s Center for Cli-
mate Change Communication, in collabora-
tion with the WHO.
A draft proposal on greening WMA meet-
ings was also considered. This was expected
to be finalized soon for submission to the
next Council session in April 2021.
The committee received the report.
Network on Disaster Medicine
The Japan Medical Association reported on
the Network on Disaster Medicine,remind-
ing the meeting that the JMA had proposed
the idea of a Network in which the United
Nations, governments, the WMA, NGOs/
NPOs, academia, and public interest orga-
nizations, and Entities collaborated. They
were convinced that the combination of
these seven parties would dramatically im-
prove the disaster medical response capa-
bilities of the WMA. It was necessary to
accumulate the improvement of large and
small-scale disaster medical response ca-
pabilities in each country for building the
seven-party collaboration.
In collaboration with the JMA and
CMAAO, AMDA, a Japan-based disaster
medicine specialist group, had already signed
agreements with several governments and
related organizations.Among them,Indone-
sia, the Philippines, Bangladesh, Myanmar,
Nepal, and Pakistan had agreements with
their respective medical associations.
On May 29, this year, the Inaugural Con-
ference of the Asia-Pacific version of the
World Platform for Disaster Medicine was
scheduled to be held, but it was postponed
by one year due to Covid-19. Depending
on the situation of the pandemic, the Japan
Medical Association was planning to hold
this international conference in 2021.
Human Rights Violations against Uighur
people in China
The emergency resolution on human rights
violations against the Uighur people in
China was presented by the British Medical
Association.
The Chinese Medical Association immedi-
ately submitted an amendment to withdraw
the resolution, arguing that it was an inter-
ference in China’s internal affairs and based
on false reports. During the fight against
Covid-19 in Xinjiang Autonomous Region
in 2020, China had always put the life and
health of people in Xinjiang Autonomous
Region first.
In the absence of a seconder, the amend-
ment fell.
The British Medical Association said the
resolution was motivated by recent numer-
ous reports about the Uighur people,a Mus-
lim ethnic minority, being detained in Chi-
nese detention centres and being forced to
make personal protection equipment for ex-
portation. Serious ongoing abuses of health-
related human rights were taking place,
including torture and the systematic sterili-
sation of Uighur women.The use of Uighur
labour to make PPE warranted an emer-
gency motion. The global health care com-
munity should not condone and encourage
modern slavery. With continuing reports of
physical abuse and forced sterilisation,it was
imperative that pressure was put on China
to allow UN investigators into the area.
By 14 votes to two, the committee agreed
that the emergency resolution be forwarded
to the Council for adoption by the Assem-
bly.
The following policy documents were ap-
proved by the committee for sending to the
Council:
• Statement on Hypertension and Cardio-
vascular Disease
• Resolution on Protecting the Future
Generation’s Right to Live in a Healthy
Environment
• Major revision of WMA Resolution on the
Access to Adequate Pain Treatment
• Major revision of the Resolution on Vio-
lence against Women and Girls
• Minor revision of the Statement on the
Relationship between Physicians and
Pharmacists in Medicinal Therapy
• Minor revision of the Resolution on
Drug Prescription
• Minor revision of the Resolution on the
Prohibition of Chemical Weapons
• Minor revision of the Resolution on the
Healthcare Situation in Syria
Pseudoscience and Pseudotherapies
The Spanish Medical Association presented
a proposed Declaration on Pseudoscience
and Pseudotherapies in the Field of Health
that it said was an attempt to warn people
about pseudoscience. During the Covid
pandemic, those spreading false rumours
and pseudotherapies had proliferated in
many countries, in particular in South
America. The WMA must act against this,
as these pseudoscience ideas undermined
the values and safety of patients.
In the debate that followed, the meeting
accepted two friendly amendments. The
American Medical Association proposed
moving to the end of the document the
first sentence that stated: ‘The aim of this
Declaration is not the traditional ances-
tral medicines nor the so-called indig-
enous medicines, firmly rooted in peoples
and nations, forming an intrinsic part of
their culture, rites, traditions and history’.
It was argued that the intent of the sen-
tence was unclear, and beginning a policy
with a negative statement weakened the
subsequent text. As explanatory material,
the sentence was best included as a foot-
note.
The AMA moved a further amendment to
delete the sentence that read: ‘The physi-
cian who practices and applies techniques
or therapies not endorsed by the scientific
community, has the duty to adequately in-
form its patients and assume all legal, pro-
fessional, ethical and deontological obliga-
tions and consequences that may arise.’ It
was argued that no physician should prac-
tice or apply techniques or therapies not
endorsed by the scientific community. This
was agreed.
BACK TO CONTENTS
9
General Assembly Report
There was also a proposal to delete the word
‘knowledge’ in the opening definition sen-
tence that read ‘“Pseudoscience” (false sci-
ence) refers to the set of statements, knowl-
edge, methods, beliefs or practices that,
without following a valid and recognized
scientific method, are falsely presented as
scientific or evidence-based’. But after a
brief debate, the amendment was defeated
by eight votes to seven.
The committee recommended that the Dec-
laration, as amended, be sent to the Council
for adoption by the Assembly.
Medical Liability
The Israeli Medical Association welcomed
comments that had been received to the
proposed revision of the Statement on
Medical Liability, which calls for an end to
frivolous medical liability claims. In view
of the comments, it was proposed that the
document be recirculated.
It was suggested that it would be helpful to
include organizational liability in reconsid-
ering the document, as it was not just in-
dividuals who were involved on this issue.
Systemic factors were often involved.
The committee recommended that the doc-
ument should be recirculated to members.
Child Health
The South African Medical Association
proposed a major revision of the WMA
Declaration of Ottawa on Child Health,
updating policy to ensure the health and
wellbeing of children.
The German Medical Association proposed
an additional paragraph inserting the words
‘respect for the sexual and gender identity
of the child. Harmful practices like genital
mutilation or so-called conversion thera-
pies must be forbidden’. It was argued that
these issues were too important not to be
mentioned in a declaration on child health.
These practices had such an impact on the
future life of a child that they needed to be
mentioned.The amendment was accepted.
The committee agreed that the Declaration,
as amended, be forwarded to the Council
for adoption by the Assembly.
Inequalities in Health
A proposed revision of the Declaration of
Oslo on social determinants of health was
tabled.It was reported that theWMA State-
ment on inequalities in health was adopted
in 2009 and had not been revised since then.
As part of the annual 10-year policy review
the secretariat recommended a major revi-
sion of the statement by integrating the rel-
evant parts of the statement in the Declara-
tion of Oslo . This new consolidated policy
on SDH should refer to Universal Health
Coverage and the Sustainable Development
Goals, specifically SDG3 and SDG10. The
Statement on inequalities in health would
then be rescinded.
The committee recommended that, as
amended, the Declaration should be sent to
the Council and forwarded to the General
Assembly for adoption.
Use of Telehealth for the Provision of Health
Care
The committee considered a proposed revi-
sion of the Statement on Guiding Princi-
ples for the Use of Telehealth for the Provi-
sion of Health Care.
A suggestion was made to set up a work-
group. The meeting was told that with
­
Covid-19, the world was using much more
telehealth and a workgroup would be very
timely. It was important that any reconsid-
eration should include the role of telehealth
in pandemics.
The committee recommended that the idea
of a workgroup should be supported.
Access to surgery and anaesthesia care
A proposed statement was tabled by the Ju-
nior Doctors Network on access to surgery
and anaesthesia care.The committee recom-
mended that the document be circulated to
members.
Relationship between Physicians and Com-
mercial Enterprises
A proposed revision of the Statement Con-
cerning the Relationship between Physi-
cians and Commercial was considered. The
Statement, warning about the conflict of
interest that can occur between physicians
and commercial enterprise, needed updat-
ing under the 10-year revision process.
After a brief debate, the committee recom-
mended that the document be approved by
the Council and forwarded to the General
Assembly for adoption.
Items Deferred
In view of time constraint, the committee
agreed to defer consideration of the follow-
ing items:
• Observer status for Taiwan to WHO and
inclusion as participating party to the In-
ternational Health Regulations
• Proposed WMA Statement on Photo-
protection
• Proposed WMA Statement in support
of Ensuring the Availability, Quality and
Safety of All Medicines Worldwide
• Medical Technology workgroup
• Revision of WMA policies related to di-
saster/pandemic preparedness and ethics
• Proposed major revision of Council Res-
olution on Trade Agreements and Public
Health
• Proposed major revision of WMA State-
ment on Family Violence
• Proposed major revision and consolida-
tion of WMA policies on migration
• Proposed minor revision of WMA Reso-
lution on Plain Packaging of Cigarettes
Wednesday October 28
Medical Ethics Committee
Dr. Andreas Rudkjoebing (Denmark) took the
chair and called the committee to order.
Reproductive Technologies
An oral report was given by the Chair of
the Reproductive Technologies workgroup
from South Africa. She reminded the meet-
ing that the workgroup was established with
the mandate to work further on the proposed
revision of the Statement on Reproduc-
tive Technologies in coordination with the
workgroup on Genetics and Medicine, given
BACK TO CONTENTS
10
General Assembly Report
the number of cross-cutting issues. A list of
existing and new ­
reproductive technologies
had been collated, and SAMA had reviewed
the potential to revise the existing statement
on reproductive technologies as a single doc-
ument, or split it into two, given the com-
plexities of new technologies that might be
included. In discussion with the secretariat,
SAMA had agreed to wait until after the
2020 online sessions to pick up and progress
the work on reproductive health issues.
The report was received.
International Code of Medical Ethics
The committee received an oral report from
the Chair of the workgroup tasked with
revising the International Code of Medi-
cal Ethics. He presented an update on the
workgroup’s progress and a timeline of the
revision process for the coming months.The
work was on track. Two successful regional
conferences had been held, and based on
the feedback from these, and a webinar, a
revised draft was available for informa-
tion. Next year an in-person meeting was
planned, along with a public consultation.
There was still ample time and opportunity
to propose amendments to the content and
language in the months ahead.
The committee recommended that the cur-
rent policy draft of the ICoME be approved
for the workgroup’s ongoing consideration.
The committee also supported the proposal
for the WMA to host a dedicated confer-
ence focused on conscientious objection.
Documentation of Torture
The meeting heard an update from the
workgroup set up to revise the proposed
Resolution on the Responsibility of Physi-
cians in the Documentation and Denounc-
ing Acts of Torture and Ill-treatment The
Chair of the workgroup spoke about the
dilemma facing physicians and the ethical
tension between the need for fully respect-
ing the confidentiality of the patient, while
at the same time fighting the horrors of tor-
ture and documenting systematic torture.
After a brief debate, the committee recom-
mended that the revised resolution be ap-
proved by the Council for forwarding to the
General Assembly for adoption.
Physicians Treating Relatives and Friends
The committee considered the proposed
Statement on Physicians Treating Relatives
and Friends submitted by the South Afri-
can Medical Association.
Delegates were told that the document re-
minded physicians of their obligations. A
debate took place on whether friends should
be included in the statement, and the Chair
agreed that friends should be omitted. Sev-
eral delegates said the wording of the state-
ment was too strong and accusatory, par-
ticularly when bearing in mind that in some
regions a physician family member might
be the only option for obtaining healthcare.
Concern was also expressed about the reac-
tion of physicians to the proposals.
A motion was made to recirculate the docu-
ment to members and this was agreed.
Physician-Patient Relationship
The Spanish Medical Association presented
the proposed Statement on Physician-
Patient Relationship, warning that the
age-old relationship was under threat. The
document had two main aims, to protect
the relationship which was both cultural
and health-related and to protect the val-
ues based on the humane nature of the re-
lationship. But this relationship was being
threatened by barriers between the two.The
Covid-19 pandemic had showed how im-
portant this issue was.
The American Medical Association pro-
posed that the title of the document should
be changed to Patient-Physician Relation-
ship, putting the patient first. It was in-
credibly important to put the patient and
patient centred care at the beginning. The
Spanish agreed that the patient should
be put above any other interest. But in
Spanish they talked about the Physician-
Patient relationship. Putting physician
first demonstrated commitment on be-
half of the medical profession to provide
quality care. This was a document directed
to physicians around the world. If it was
called the Patient-Physician Relationship,
it would be thought it was coming from a
patients’ association.
In a vote, it was agreed by eight votes to five
to change the title to Patient-Physician Re-
lationship.
The committee agreed to recommend that
the document be called The Declaration of
Cordoba.
The committee recommended that the
Declaration, as amended, be forwarded to
the Council for adoption by the Assembly.
Embryonic Stem Cell Research
The American Medical Association pre-
sented a proposed revision of the Statement
on Embryonic Stem Cell Research. This
stated that public concern about the abuse
of stem cell research could be alleviated if
laws were adopted in line with established
ethical principles.
After a brief debate, the statement was ap-
proved for forwarding to the Council for
adoption by the Assembly
Gene-Editing
A proposed Statement on Gene-Editing was
submitted by the South African Medical As-
sociation. This warned physicians to avoid
getting involved in unethical or unapproved
human gene-editing research, and listed
recommendations for national medical as-
sociations following what it called ‘alarming
reports on abuse’of the emerging technology.
The British Medical Association proposed
two amendments. The first suggested add-
ing to the sentence ‘There are also concerns
that germline modifications could create
classes of individuals defined by the qual-
ity of their engineered genome, possibly
enabling eugenics’, the additional words
‘which could exacerbate social inequalities
or be used coercively’.This was agreed
The second was to add a new paragraph
reading: ‘The effect of epigenomic changes
are unpredictable, and there is disquiet as to
how this will affect the existing healthy bio-
logical systems, including interactions with
other genetic variants, and societal norms.
Once introduced into the human popula-
BACK TO CONTENTS
11
General Assembly Report
tion, genetic alterations would be difficult
to remove and would not remain within any
single community or country. The effects
could remain uncertain for many subsequent
generations, during which time deleterious
modifications could be dispersed throughout
the population’.This was also agreed.
The committee recommended that the
statement, as amended, be approved by the
Council and forwarded to the General As-
sembly for adoption.
Physicians’ Responsibilities in Preventing and
Combating Transplant-related Crimes
The Spanish Medical Association submit-
ted a proposed Statement on Physicians’ Re-
sponsibilities in Preventing and Combating
Transplant-related Crimes. This called for
the strengthening of legislation to prohibit
and criminalize human organ trafficking. It
was argued that transplants had been a ma-
jor progress in modern medicine for health
and humanitarian reasons. But this had led
to organ trafficking and had affected human
rights, with risks for individuals and for pub-
lic health. It meant exploitation for the most
vulnerable and it required the participation of
health care professionals,particularly doctors.
It was argued that doctors should be helping
to combat these crimes. This Statement was
aimed at eradicating the trafficking of human
organs. The WMA needed to provide guid-
ance to doctors on how to react when they
found themselves in different situations.They
needed to inform patients of the consequenc-
es of trafficking.When doctors dealt with pa-
tients who had obtained organs illegally, they
needed to notify the authorities.
The American Medical Association pro-
posed an amendment stating that Govern-
ments should ‘vigorously enforce’ legislative
frameworks to prohibit and criminalize traf-
ficking, arguing that laws were powerless if
not enforced. The amendment was accepted.
A second amendment from the AMA called
for national medical associations to develop
‘mandatory frameworks’ for health profes-
sionals to report any confirmed or suspected
case of trafficking and that reports on an
anonymous basis should be permitted.
This led to a debate in which some speakers
opposed the word ‘mandatory’, while others
questioned what was meant by ‘anonymous’.
The Spanish opposed recirculation.
The committee eventually decided to ap-
prove the document for forwarding to
Council, while discussions continued to
find a compromise on the wording of ‘man-
datory’ and ‘anonymous’.
Declaration of Venice
The committee was told that following last
year’s WMA policy decision on euthanasia
and physician assisted suicide, a major revi-
sion of the Declaration of Venice on Ter-
minal Illness was needed. The American
Medical Association volunteered to act as
rapporteur for a major revision.
Women’s right to Health Care and How that
Relates to the Prevention of Mother-to-Child
HIV Infection
The South African Medical Association
proposed a major revision of the WMA
Resolution on Women’s right to Health
Care and How that Relates to the Pre-
vention of Mother-to-Child HIV Infec-
tion.
The committee decided that the proposed
resolution should be circulated to constitu-
ent members for comment.
Declaration on Principles of Health Care for
Sports Medicine
The committee considered the first draft of
a proposed major revision of the Declara-
tion on Principles of Health Care for Sports
Medicine submitted by the American Med-
ical Association.This reiterated the WMA’s
opposition to World Athletics’ rules requir-
ing female athletes with differences in sex
development to take drugs to reduce and
maintain their natural level of blood testos-
terone in order to compete.
The committee recommended that the doc-
ument be circulated for comment.
Declaration of Geneva
A proposal to amend the French version of
the Declaration of Geneva was put forward
to bring it into line with other WMA docu-
ments. The English version ‘I will maintain
the utmost respect for human life’ should
read in French ‘Je veillerai au plus grand re-
spect de la vie humaine’ not Je veillerai au
respect absolu de la vie humaine’.
The committee recommended that the pro-
posed revision be forwarded to the General
Assembly for adoption.
WMA Council Resolution on Organ Donation
in China
The Chinese Medical Association submit-
ted a proposal to revoke the WMA Council
Resolution on Organ Donation in China. It
argued that the resolution from 2006 was
now outdated and not consistent with to-
day’s situation. The meeting was told that
after years of reforms starting in 2015, Chi-
na had stopped transplanting organs from
executed prisoners. As a result, the situa-
tion in China was as transparent as in other
member states in the WHO.
However, the American Medical Associa-
tion opposed revocation, saying that offi-
cial information was not yet available.The
German Medical Association proposed to
invite the Chinese to officially condemn
any practice in violation of ethical prin-
ciples and basic human rights and to as-
sure people that Chinese doctors were not
involved in the removal or transplantation
of organs from executed Chinese prison-
ers.
The Chinese said they understood the re-
quest and said that in 2015 the Chinese
Medical Journal had published a very clear
statement that organs should not be trans-
planted from executed prisoners. The data
was public. They argued that the WMA
Resolution of 2006 was sending the wrong
message to the public.
The committee recommended that the Chi-
nese proposal to revoke the resolution be
sent to the Council for adoption by the Gen-
eral Assembly. Meanwhile, the ­
proposal by
the German Medical Association for China
to officially condemn the practice should be
considered by the Council together with the
initial proposal
BACK TO CONTENTS
12
General Assembly Report
Thursday October 29
Resumed Council
The Chair of Council, Dr. Montgomery,
welcomed two new members of Council,
Dr. Camilla Rathcke, Chair of the Danish
Medical Association, replacing Dr. Andreas
Rudkjoebing, and Dr. Omar Khorshid from
the Australian Medical Association.
Hong Kong
The Chinese Medical Association pro-
posed a motion to amend the section on
Hong Kong in the Council report relat-
ing to the WMA press release denounc-
ing a reported breakdown of medical care
and humanitarian assistance for protesters
in Hong Kong. The Chinese argued that
there was not a breakdown of medical care
in Hong Kong as stated in the report. But
in the absence of a seconder, the motion
was not pursued.
The Council then considered reports from
the three committees
Medical Ethics Committee
The Council accepted the following items
from the committee for forwarding to the
Assembly for adoption:
• International Code of Medical Ethics
• Reproductive Technologies
• Patient-Physician Relationship
• Documentation of Torture
• Physicians Treating Relatives
• Declaration of Venice
• Resolution on the Women’s right to
Health Care and How that Relates to the
Prevention of Mother-to-Child HIV In-
fection
• Declaration on Principles of Health Care
for Sports Medicine
• Declaration of Geneva – French version
Stem Cell Research
The Statement on Embryonic Stem Cell
Research was considered.The British Medi-
cal Association referred to the sentence that
read ‘Investigational stem cell products also
may pose unique risks, including unknown
long-term health effects such as mutations
and possible cancers’. They wanted a clear
definition of the words ‘Investigational
stem cell products’, clarifying whether this
referred to pluripotential stem cells or to
something else.
They also proposed an amendment to de-
lete the reference to cancer. The beginning
of the sentence stated that the risks were
unknown. So if they were truly unknown,
they should be cautious in suggesting a link
to cancer.
The proposal to delete the word cancer was
accepted and the meeting agreed to recom-
mend that the document, as amended, be
forwarded to the Assembly for adoption.
Gene Editing
The Council considered the Statement on
Gene Editing as amended in the committee
following suggestions by the British Medi-
cal Association.
The Council recommended that the docu-
ment, as amended, be forwarded to the As-
sembly for adoption.
Transplant Related Crimes
The proposed Statement on Physicians’Re-
sponsibilities in Preventing and Combating
Transplant-related Crimes was considered.
The British Medical Association said it was
not happy with the proposal for national
medical associations to develop ‘manda-
tory frameworks’ for health professionals to
report any confirmed or suspected case of
trafficking.The BMA wanted to see doctors
left with professional discretion. It was pro-
posed that the document should be amend-
ed to read ‘National medical associations
should advocate for the ability of health
professionals to report suspected trafficking
of individual persons, on an anonymous ba-
sis if necessary, to protect the safety of the
reporter. Where applicable, the reporting
of trafficking cases should be a permitted
exception to the physician’s obligation to
maintain patient confidentiality’.
The amendment was approved and the
Council recommended that the statement,
as amended, be forwarded to the Assembly
for adoption.
Organ Donation in China
Further debate took place on the Chinese
Medical Association proposal to revoke the
2006 WMA Resolution on organ donation
in China on the grounds that it was out of
date. The Council considered a three-part
amendment from the German Medical
Association inviting the Chinese Medical
Association to condemn the removal of or-
gans from executed prisoners, to ensure that
Chinese doctors were not involved in the
removal or transplantation of organs from
executed prisoners and that no more organs
from executed prisoners would be used for
transplantation or even accepted as dona-
tions in China.
The Chinese responded by arguing again
that the original resolution was outdated
and contradicted WHO and international
experts.The resolution sent the wrong mes-
sage to the public. The Chinese Medical
Association said it would have no trouble
in agreeing to the German amendment, but
suggested they needed more time for fur-
ther discussions with the German Medical
Association.
The Chair of Council proposed that the
German amendment be postponed for dis-
cussions to take place.This was agreed.
Further debate then took place on the
original Chinese motion to revoke the 2006
Resolution. The Chinese delegate again
outlined the progress that had been made in
his country on this issue,but other delegates
argued that it would be premature for the
WMA to withdraw its resolution.
In a vote on the Chinese motion to revoke
the 2006 Resolution, the Council decided
by eighteen votes to two with three absten-
tions not to revoke the resolution.
Finance Committee report
The Council accepted the report of the Finance
and Planning Committee without debate.
Social Medical Affairs Committee
Human Rights Violations against Uighur
people in China
The Council considered the emergency res-
olution on human rights violations against
BACK TO CONTENTS
13
General Assembly Report
the Uighur people in China presented by
the British Medical Association.
The BMA emphasised again the importance
of this resolution to bring pressure to bear
on China. A strong motion from the WMA
would help to take this matter forward.
In a lengthy response, the Chinese Medical
Association again opposed the resolution,
arguing that the allegations were based en-
tirely on a few very flawed and discredited
reports by non-governmental organisations,
which were contrary to the scientific spirit
and ethics expected of medical organisa-
tions. The CMA said the WMA General
Assembly should not be used as a place for
individual members to engage in political
manipulation. There had never been such
a thing as re-education camps in Xinjiang.
The vocational education and vocational
training centres in Xinjiang as well as other
counter-terrorism and de-radicalization
measures taken there had led to positive
outcomes, making important contribu-
tions to the global fight against terrorism
and radicalization. The rights and interests
of workers from Xinjiang were protected
by China’s Labor Law and Labor Contract
Law.In the face of false reports,the Chinese
Medical Association resolutely opposed the
resolution and demanded that it be rejected.
On a vote, the Council accepted the resolu-
tion by 19 votes to two.
Pseudoscience
The Council considered the proposed Dec-
laration on Pseudoscience and Pseudother-
apies in the Field of Health.
The Chinese Medical Association proposed
an amendment to the definition at the start
of the document so that it should read
‘“Pseudoscience” (false science) refers to the
set of statements, assumptions, methods’,
inserting the word ‘assumptions’ instead of
‘knowledge’.This was agreed.
The Spanish Medical Association proposed
a further amendment to the line in the defi-
nition which read ‘“Pseudotherapies” (false
therapies) are those unproven alternative
therapies intended for curing diseases, alle-
viating symptoms or improving health with
procedures‘. The amendment was to replace
the words ‘unproven alternative thera-
pies’  with the word ‘practices’. On a vote,
the amendment was agreed by 14 votes to
six, with one abstention.
The Council recommended that the Decla-
ration, as amended should be forwarded to
the Assembly for adoption.
Policies for Major Revision
The Council agreed that three policy docu-
ments should be circulated for comment in
preparation for major revision:
• Trade Agreements and Public Health
• Family Violence
• Migration and Health
World Health Organisation
The Secretary General reported on the 2020
World Health Assembly which had to be
changed to a shorter meeting because of the
pandemic.
He said there had been harsh criticism of
the WHO by the American President,Don-
ald Trump,for being under too strong an in-
fluence from China,having reported too late
and taken decisions too late on the spread
of Covid-19. Mr Trump had terminated
his country’s membership of WHO and
this had raised a lot of criticism from both
sides. As a result, the process of reforming
the WHO had come to an abrupt stop, as
the US was the biggest payer to the WHO.
Dr. Kloiber said that most member states
now used other channels to pay for global
health. These were now the big players who
received money from donors and states, and
not the WHO. The budget of the WHO
was probably the same size as the budget of
a big hospital in the US.To expect too much
from the WHO was not realistic. He said
the WMA had made its position clear in a
press release that it did not think the USA
was correct in withdrawing from the WHO.
The WHO was now proceeding with its re-
view and he hoped nations would stay on
board to support reform. The WMA was
looking forward to co-operating.
The American Medical Association said it
had gone on record saying it did not believe
that the US should withdraw funding from
the WHO, particularly during a pandemic.
The Chinese Medical Association refuted
claims that China had delayed sharing in-
formation about the outbreak of Covid-19
in the early part of this year.There had been
open transparency and China had shared
the available information as quickly as they
could.
Socio-Medical Affairs Committee
The Council was told that items not dis-
cussed at this week’s meeting would be
deferred until a resumed SMAC meeting,
later fixed for 12 January 2021. The Brit-
ish Medical Association suggested that it
would be far more useful, if they were going
to meet in December, that they continue
discussing Covid-19 at a special meeting
next month.
The Chair of Council said this idea would
be followed up. He agreed they should have
a day to discuss Covid-19 and learn about
experiences worldwide.
Any Other Business
President of Brazilian Medical Association
The President of the Brazilian Medical As-
sociation said a few words before finishing
his term of office. This was his last meeting
at the WMA and he offered his thanks to
the WMA.
International Symposium on Vaccination
The Council was told that the Internation-
al Symposium on Vaccination, originally
scheduled for May this year, had now been
rescheduled for July 1 and 2 2021.
Nuclear War
Bjoern Oscar Hoftvedt, Chair of the Board
of The International  Physicians for the
­Prevention of  Nuclear War, informed the
Council of the good news that the UN Treaty
on the Prohibition of Nuclear Weapons was
adopted by the 50th
state last Saturday. He
said he was very grateful for all the sup-
port for the Treaty that had come from the
WMA. With this ratification, the Treaty
would come into force on January 22.
BACK TO CONTENTS
14
General Assembly Report
Friday October 30
General Assembly Ceremonial Session
The session was called to order by the Chair
of Council,Dr.Frank Montgomery.He said
it was sad they were having to meet online,
but the pandemic had a hard grip on them.
A formal roll call was taken.
President of Spanish Medical Association
Dr. Serafín Romero, President of the Span-
ish Medical Association, welcomed del-
egates to the Cordoba Assembly. He paid
tribute to those physicians who had tragi-
cally lost their lives during the pandemic
and to those physicians who were fighting
complications linked to the infection. He
said the Spanish Medical Association had
always been a member of the WMA, always
committed to promoting the medical pro-
fession and its ethical principles. The Span-
ish Medical Association was celebrating its
100th
anniversary with the motto ‘Commit-
ted to society, Committed to doctors’, and
they wanted to underscore the values of
professionalism, which was very much to do
with putting patients first. He emphasised
how important it had been for Cordoba
to host this Assembly so that the Spanish
Medical Association could demonstrate its
active role in the WMA. They also wanted
the Assembly to be a gesture of solidarity
with Latin America. He said the Assembly
needed to send out a message of support to
doctors with discussions on many important
issues.They needed to strengthen the doctor
patient relationship and he hoped the As-
sembly would pay tribute to this relationship
and approve the Declaration of Cordoba.
Prime Minister of Spain
The Prime Minister of Spain,Mr Pedro San-
chez, then addressed the Assembly. He said
it had given him great pride for Spain to host
such an important Assembly on the 100th
anniversary of the Spanish Medical Associa-
tion.This was particularly so in the middle of
a pandemic, a crisis that was affecting all of
them the world over. No country had been
spared by the pandemic. It had been a hum-
bling experience for all the world’s govern-
ments, forcing them to rethink how they op-
erated on a daily basis. It made them realise
that without science, without the medical
profession they could not achieve anything
at all. Physicians had been at the forefront
of efforts to combat the pandemic, working
tirelessly, giving their all, sometimes giving
their own lives, often working in inhumane
conditions enduring unbearable pressure in
hospitals. They had had to put up with mis-
information, unscientific lies and negativism.
Physicians were a human shield against the
pandemic.But he asked who took care of the
physicians.He reassured physicians that they
were not alone. It was very clear to public
institutions that without the medical pro-
fession’s dedication and devotion there was
no future possible.The pandemic had taught
them an important lesson. Governments
and societies must invest in public health
and must strengthen health systems whose
weaknesses had come to light during this
crisis. They had to do this with great resolve
and without hesitation,making the necessary
investment and the honouring a profession
that was perhaps the worthiest of all, that of
saving lives and caring for lives. This lesson
was abundantly clear to the WHO and to
the European Union. And it was a priority
for the Government of Spain to contain this
second wave of the pandemic as quickly as
possible.
Mr Sanchez concluded with a simple mes-
sage to the millions of physicians who were
working all over the planet – ‘Thank you’.
Dr. Miguel Jorge, the outgoing President of
the WMA, invited the Secretary General to
read out the Declaration of Geneve for del-
egates to recite online.
Dr. Jorge then led the meeting in paying
tribute to the world medical community
on the front line fighting the pandemic,
especially to those physicians who had lost
their lives in the fight. During one minute
of silence, the names of deceased physicians
were pictured on the screen.
The Chair of Council, Dr. Montgomery,
paid tribute to the outgoing President,
Dr. Jorge. He said there had never been a
President whose term of office coincided so
dramatically with a global pandemic. None
of them expected things to develop as they
did when things changed. When they did,
Dr Jorge had fought for nurses, physicians
and health care workers. This had become
the overarching subject of his Presidency,
for which Dr. Montgomery thanked him
on behalf of the whole Association.
Valedictory Address (see p. 2)
Dr.Miguel Roberto Jorge then delivered his
Valedictory Address.
Installation of New President
Dr.David Barbe,from the American Medi-
cal Association, was installed as President
for 2020-21 by the Chair of Council.
Inaugural Address (see p. 3)
Dr. Barbe delivered his Inaugural Address.
General Assembly Plenary Session
Election of President
Dr. Heidi Stensmyren, President of the
Swedish Medical Association, was elected
unopposed as President for 2021-2022.
She said she was honoured to be elected.
They were living in challenging times and
this would not be over this year. But they
were developing strategies and developing
treatments as physicians had done for cen-
turies. She said they must continue to con-
tribute their expertise and she hoped the
WMA would extend its collaboration with
the WHO and other organisations con-
cerning issues such as adequate and safe
vaccine programmes and access to health
care. The WMA had an important role in
stressing equality of access to vaccines, in
sharing knowledge and expertise and in
fostering access to testing, medication and
vaccines.
Report of Council
The following policies were adopted by the
Assembly:
• Resolution regarding the Medical Profes-
sion and COVID-19 (see p. 31)
BACK TO CONTENTS
15
General Assembly Report
• Resolution in support of an International
Day of the Medical Profession, Octo-
ber 30 (see p. 22)
• Resolution on equitable global distribu-
tion of COVID-19 vaccine (see p. 24)
• Resolution in support to the Turkish
Medical Association (see p. 23)
• Resolution on the responsibility of physi-
cians in the documentation and denounc-
ing acts of torture and ill-treatment treat-
ment (see p. 28)
• Statement on Gene-Editing (see p. 33)
• Statement on Physicians’ Responsibili-
ties in Preventing and Combating Trans-
plant-related Crimes (see p. 36)
• Revision of the French version of the
WMA Declaration of Geneva
Patient-Physician Relationship
The Assembly considered the proposed State-
ment on Patient-Physician Relationship.
Dr.Serafín Romero (Spain) told the Assembly
that in committee the title of the document
had been changed from Physician-Patient
Relationship to Patient-Physician Relation-
ship. He said he would like the Assembly to
take the decision about which title to use.The
reason the document was originally called the
Physician-Patient Relationship was because
this term was more widely understood in
Spain and in Portugal and France. He under-
stood that the American Medical Association
wanted the title to be Patient-Physician Re-
lationship. But the WHO in its publications
used the expression Physician-Patient and
on Google there were three million hits for
Physician-Patient and only 200,000 hits for
Patient-Physician. He said it was important
for Spain that the title was Physician-Patient
Relationship.He asked who was bringing this
document forward – the medical profession.
And who was it particularly aimed at – phy-
sicians and medical students. He proposed
that the title of the document be changed to
Physician-Patient Relationship.
Dr. Montgomery suggested a compromise
under which the title was translated dif-
ferently in different parts of the world.
Dr.  Romero accepted that as a friendly
amendment and a solution.
The Assembly adopted the document as
the Declaration of Cordoba, on the un-
derstanding that it be titled Patient-Phy-
sician Relationship in the English version
and Physician-Patient Relationship in the
French and Spanish versions.
Embryonic Stem Cell Research 
The Assembly considered the proposed re-
vised Statement on Embryonic Stem Cell
Research. Prof. Pablo Requena (Vatican
Medical Association) said he would vote
against the document. He said he agreed
with clinical research to try to find thera-
pies, provided that this respected all human
life.The Declaration of Geneva, which they
had all just recited, said that they would
maintain the utmost respect for human life.
He believed this document ran counter to
this Declaration and therefore he would be
voting against.
On a vote,the Statement was adopted by 88
votes to four with eight abstentions.
The Assembly received for information the
following policies:
• Revised Statement on the Relationship
between Physicians and Pharmacists in
Medicinal Therapy
• Revised Resolution on Drug Prescription.
• Revised Resolution on the Healthcare Situ-
ation in Syria
• Revised Resolution on the Prohibition of
Chemical Weapons
The following policies were adopted:
• Statement on Hypertension and Cardio-
vascular Disease (see p. 34)
• Resolution on Protecting the Future
Generation’s Right to Live in a Healthy
Environment (see p. 26)
• Revised resolution on the Access to Adequate
Pain Treatment (see p. 27)
• Revised resolution on Violence against
Women and Girls (see p. 39)
• Declaration on Pseudoscience and Pseu-
dotherapies in the Field of Health (see
p. 21)
• Revised Declaration of Ottawa on Child
Health (see p. 19)
• Revised Declaration of Oslo on Social
Determinants of Health (see p. 18)
• Revised Statement Concerning the Re-
lationship between Physicians and Com-
mercial Enterprises (see p. 31)
• Resolution on Threats to Professional
Autonomy in Turkey
• Resolution in Support of Dr Serdar Küni
(see p. 23)
Human Rights Violations against Uighur
people in China
The Assembly considered the Resolu-
tion on Human Rights Violations against
Uighur people in China proposed by the
British Medical Association. This formally
condemned the treatment of the Uighurs in
China’s Xinjiang region
Dr. Shuyang Zhang (China) opposed the
resolution. He said it ignored facts and evi-
dence and completely violated scientific evi-
dence, citing false information. These were
reports from non-governmental associations
full of holes. He said the WMA should not
be used for political manipulation. It was not
fair to adopt this resolution and would cause
great damage to the WMA’s reputation.This
issue was a highly political one and should
not be considered at this Assembly.
Dr. John Chisholm (British Medical Asso-
ciation) strongly refuted the claim that this
was a motion intended to achieve political
manipulation. It was an approach that was
determined to respect human rights and
particularly the health-related human rights
for the Uighur people. It was also alleged it
was factually incorrect and that the motion
was based on false reports. There were nu-
merous organisations that had reported the
abuses, including Amnesty International,
Human Rights Watch, the US Council on
Foreign Relations and the British Govern-
ment.He said he would like to highlight the
significance and importance of the resolu-
tion regarding the human rights violations.
As doctors of the world, they should not
condone unethical trade practices that were
detrimental to the heath of populations
globally and they should not be encourag-
ing modern slavery. The continuing reports
of political indoctrination, torture, forced
sterilizations, forced abortions of minorities
BACK TO CONTENTS
16
General Assembly Report
generated serious concern about widespread
state-sponsored violations in China. It was
imperative that awareness of this situation
continued to grow and further pressure was
put on the Chinese Government to allow an
independent United Nations investigation
into what was happening. He hoped that
this resolution would be adopted to show
that the WMA stood out against heath-
related human rights abuses.
The Chinese delegate responded again, say-
ing that since 2018 nearly a thousand visi-
tors from more than 90 countries had visited
Xinjiang, seeing for themselves the social
stability.He said that forced labour by means
of violence, threat, or beating, was strictly
prohibited. China protected their human
rights in Xinjiang. He asked if anyone at the
meeting had been to the area. He had been
working there. He had many friends and
relatives living there and in China they knew
the truth of the human rights situation there.
Dr. Chisholm replied that while they had not
witnessed the abuses personally that was not
a suitable criterion on which to judge human
rights abuses. But he must point out that eye-
witness evidence did exist.The resolution called
for independent investigators to be allowed
access to the Xinjiang region. He understood
the Chinese had not agreed to this request.
On a vote, the resolution was adopted by 85
votes to eight with seven abstentions.
Declaration of Oslo on Social Determinants of
Health
Tomas Hedmark (Sweden) proposed that
the Assembly not only adopt the revised
Declaration of Oslo but also rescinded the
WMA Statement on Inequalities in Health.
One of the purposes of the Declaration
was to incorporate relevant parts from the
Statement on Inequalities.
The proposal was approved.
Finances
The Treasurer, Dr Ravindra Sitaram
Wankhedkar, presented his report on the
finances of the Association.
He spoke about the Financial Statement
for 2019 and the budget for 2021, giving an
outline of the Association’s assets, income
and expenditure. He said the Association’s
finances were very solid.
The Assembly approved the Financial State-
ment for 2019 and the Budget for 2021.
The Assembly received the following docu-
ments for information:
• Report on Membership Dues Payments
for 2020
• WMA Dues Categories 2021
• The date for the 226th
Council Session in
2024 to be 18-20 April 2024
The meeting also agreed the following:
• That the dues increase of 2.5% for dues
categories C and D be postponed until
the increase becomes necessary
• That the 75th
General Assembly be held
from 2-5 October 2024
• The invitation from the Finnish Medical
Association in Helsinki to host the 75th
General Assembly in 2024
• That “Global response to antimicrobial
resistance, in the context of COVID-19”
be the theme for the Scientific Session of
the General Assembly, in London 2021
Membership
The Assembly agreed that the application
for constituent membership of Círculo Par-
aguayo de Médicos be approved and that
the application to rejoin constituent mem-
bership from the Royal Dutch Medical As-
sociation also be approved.
Associate Members
Dr. Ankush Bansal reported on the recent
virtual meeting of the Associate Members
and the re-election of the Chair, Dr. Joseph
Heyman for 2020-23.
He proposed a Resolution on LGBTQ
Equity in Venues Hosting WMA Meet-
ings and Functions.This recommended that
it should be WMA practice to consider
the safety of its delegates and guests when
choosing a host nation for WMA meetings
and events. This should include discrimina-
tion against or criminalizing members of
the LGBTQ community.
The Assembly agreed to circulate the docu-
ment.
Any Other Business
Dr. Montgomery said the WMA was cel-
ebrating the 10th
anniversary of the Junior
Doctors Network. Dr. Yassen Tcholakov,
Chair of the JDN, said the Network was
hoping to increase its work supporting the
WMA and planned a special edition of the
JDN newsletter.
72nd
General Assembly
Dr. Chaand Nagpaul (British Medical As-
sociation) showed a video of London, the
venue for the 72nd
Assembly in October
2021. He said that in 2021 the spotlight
would be on the UK as the country took
centre stage with the climate talks. It was
also the year when the UK took the helm
of the G7.
Vaccination Symposium
It was reported that the Vaccination Sym-
posium, co-organised by the WMA, the
German Medical Association, the Pon-
tifical Academy for Life and the Pontifical
Academy of Sciences, originally scheduled
for May this year at the Vatican, had now
been rescheduled for July 1 and 2 in 2021.
They were working on an updated pro-
gramme to take account of Covid-19. The
Assembly was told that the symposium was
more relevant than ever.
Human Rights Violations against Uighur
people in China
Dr. Zhang Shuyang (China) again ex-
pressed his strong indignation and regret
about the resolution adopted on the Uighur
people. The Chinese Medical Association
would never accept the resolution.
2021 Council
Dr. Jung Yul Park (Korea) said it seemed
that the Council meeting due to be held
in Seoul in April 2021 might not be able
to be held as an in-person meeting. But at
least they would be able to have an online
meeting.
The Assembly ended with thanks from
Dr. Kloiber to all those who had helped or-
ganise the virtual meeting.
BACK TO CONTENTS
17
General Assembly Report
WMA Declaration of Cordoba on
Patient-Physician Relationship
Adopted by the 71st
WMA General Assembly (online), Cordoba, Spain,
October 2020
Preamble
The patient-physician relationship is part of a human relationship
model that dates back to the origins of medicine. It represents a
privileged bond between a patient and a physician based on trust. It
is a space of creativity where information, feelings, visions, help and
support are exchanged.
The patient-physician relationship is a moral activity that arises from
the obligation of the physician to alleviate suffering and respect the
patient’s beliefs and autonomy. It is usually initiated by mutual con-
sent – expressed or implied – to provide quality medical care.
The patient-physician relationship is the fundamental core of medi-
cal practice.It has a universal scope and aims at improving a person’s
health and wellbeing. This is made possible by knowledge sharing,
common decision making, patient and physician autonomy, help,
comfort and companionship in an atmosphere of trust. Trust is an
inherent component of the relationship that can be therapeutic in
and of itself.
The patient-physician relationship is essential to patient-centred
care. It requires both the physician and the patient to be active
participants in the healing process. While the relationship encour-
ages and supports collaboration in medical care, competent patients
make decisions that direct their care.The relationship may be termi-
nated by either party. The physician must then assist the patient in
securing transfer of care and refer the patient to another physician
with the necessary ability to continue the care.
The patient-physician relationship is a complex issue subject to
myriad cultural, technological, political, social, economic or profes-
sional influences. It has evolved throughout history, according to
culture and civilisation, in the pursuit of what is most appropriate
based on scientific evidence for patients by improving their mental
and physical health and well-being and alleviating pain. The rela-
tionship underwent deep changes as a result of momentous mile-
stones such as the Universal Declaration of Human Rights (1948),
the WMA declarations of Geneva (1948), Helsinki (1964), and the
Lisbon (1981).The relationship has slowly progressed towards the
empowerment of the patient.
Today, the patient-physician relationship is frequently under threat
from influences both within and outside health care systems. In
some countries and health care systems, these influences risk alien-
ating physicians from their patients and potentially harming pa-
tients. Amongst those challenges likely to undermine the therapeu-
tic efficacy of the relationship, we note a growing trend to:
• A technologization of medicine, sometimes leading to a mecha-
nistic view of health care, neglecting human considerations;
• The dilution of trustworthy relationships between people in our
societies, which negatively influences healthcare relationships;
• A primary focus on economic aspects of medical care to the detri-
ment of other factors, posing sometimes difficulties to establish
genuine relationships of trust between the physician and the pa-
tient.
It is of the utmost importance that the patient-physician relation-
ship addresses these factors of influence in such a way that the re-
lationship is enriched, and that its specificity is warranted.The rela-
tionship should never be subject to undue administrative, economic,
or political interferences.
Recommendations
Reiterating its Declaration of Geneva,the International Code of Medi-
cal Ethics and its Lisbon Declaration on Patient Rights and given the
vital importance of the relationship between physician and patient
in history and in the current and future context of medicine, the
WMA and its Constituent Members:
1. Reaffirm that professional autonomy and clinical independence
are essential components of high-quality medical care and med-
ical professionalism, protecting the right of the patients to re-
ceive the health care they need.
2. Urge all actors involved in the regulation of the patient-phy-
sician relationship (governments and health authorities, medi-
cal associations, physicians, and patients) to defend, protect and
strengthen the patient-physician relationship, based of high-
quality care, as a scientific, health, cultural and social heritage.
3. Call on Constituent Members and individual physicians to pre-
serve this relationship as the fundamental core of any medical
action centred on a person, to defend the medical profession
and its ethical values, including compassion, competence, mu-
tual respect, and professional autonomy, and to support patient-
centred care.
4. Reaffirm its opposition to interference from governments, other
agents and institutional administrations in the practice of medi-
cine and in the Patient-physician
5. Reaffirm its dedication to providing competent medical service
in full professional and moral independence, with compassion
and respect for human dignity.
BACK TO CONTENTS
18
General Assembly Report
6. Commit to address emerging factors which could pose a threat
to the patient-physician relationship and to take action to miti-
gate against those factors.
WMA Declaration of Oslo on
Social Determinants of Health
Adopted by the 62nd
WMA General Assembly, Montevideo, Uruguay,
October 2011, the title (Statement to Declaration) changed by the 66th
WMA General Assembly, Moscow, Russia, October 2015, Amended by
the 71st
WMA General Assembly (online), Cordoba, Spain, October 2020
Preamble
The social determinants of health are the conditions in which peo-
ple are born, grow, are educated, live, work and age; and the societal
influences on these conditions. The social determinants of health
are major influences on both quality of life, including good health,
and length of disability-free life expectancy. Social determinants of
health also include the impact of racism and discrimination, not
just from an individualized or interpersonal perspective, but from
structural and institutional perspectives.
While health care aims to cure and restore health, it is these so-
cial,cultural,environmental,economic and other factors that are the
major causes of rates of illness and, in particular, the magnitude of
health inequities.
Achieving health equity for all requires strong commitment from
governments, the health care sector, health professionals and the
international community among others. The UN Sustainable De-
velopment Goals (SDG)* specifically aims to ensure healthy lives
and promote well-being for all at all ages (goal 3), to ensure inclu-
sive and equitable education and promote lifelong learning oppor-
tunities for all (goal 4) and to reduce inequality within and among
countries (goal 10). In the WMA Statement on Access to Health Care,
the WMA stresses the importance of health care access for all and
suggests ways to act on inadequate access and health inequalities.
The WMA further supports and promotes the introduction of ad-
equate Universal Health Coverage in all countries.Universal Health
Coverage will improve access to appropriate health care for all and
thus promote awareness of and action on the social determinants
of health.
*  https://www.un.org/sustainabledevelopment/sustainable-development-goals/
Historically, the primary role of physicians and other health care
professionals has been to treat the sick – a vital and much cherished
role in all societies.To a lesser extent, health care professionals have
dealt with individual exposures to the causes of disease – smoking,
obesity, and alcohol in chronic disease, for example. These familiar
aspects of lifestyle can be thought of as ‘proximate’causes of disease.
The work on social determinants goes far beyond this focus on prox-
imate causes and considers the “causes of the causes”. For example,
smoking, obesity, alcohol, sedentary lifestyle are all causes of illness.
A social determinants approach addresses the causes of these causes;
and in particular how they contribute to social inequities in health.
This approach focuses not only on individual behaviors but seeks
to address the social and economic circumstances that give rise to
premature poor health, throughout the life course. The voice of the
medical profession has been and continues to be important in tack-
ling these causes of the causes.
In many societies,unhealthy behaviors follow the social gradient: the
lower in the socioeconomic hierarchy,the higher the rate of smoking,
the worse the diet, and the less the physical activity. Central to the
issue of addressing social determinants of health is the close interre-
lation between poverty and illness.A major,but not the only,cause of
the social distribution of these causes is level of education. Structural
inequity can also make access to healthy food difficult.
Specific examples of addressing the causes of the causes are: regu-
lating the price and availability of alcohol, which are key drivers
of alcohol consumption; and promoting tobacco taxation, package
labeling, bans on advertising and smoking in public places, all of
which have had demonstrable effects on tobacco consumption.
There is a growing movement globally that seeks to address gross
inequities in health and length of life through action on the so-
cial determinants of health.This movement has involved the World
Health Organization, several national governments, civil society or-
ganizations, and academics. Solutions are being sought and knowl-
edge shared. Physicians need to be well informed about the impli-
cations of perpetuating inequalities and be willing to participate in
this debate. They can be advocates for action on social conditions
that have important effects on health and for strengthening of pri-
mary care and public health institutions.The medical profession can
contribute significantly to public health, including through working
with other sectors to find innovative solutions.
Recommendations
1. The WMA and National Medical Associations should take an
active role in combating social and health inequities and barriers
to obtaining health care, striving to enable physicians to provide
BACK TO CONTENTS
19
General Assembly Report
equal,high quality health care to all.Adequate Universal Health
Coverage in all countries should be a core objective as it will
help reduce health inequity.
2. The WMA can add significant value to the global efforts to ad-
dress the social determinants of health by helping physicians,
other health professionals and National Medical Associations to
understand what the emerging evidence shows and what works
in different circumstances.WMA can call on physicians to lobby
more effectively within their countries and across international
borders and ensure that medical knowledge and skills are shared.
3. The WMA should help to gather data on successful initiatives
and help to engage physicians and other health professionals
in sharing experiences and implementing new and innovative
solutions.
4. The WMA should work with National Medical Associations to
promote education to medical students and physicians on health
inequity and the social determinants of health, and to put pres-
sure on national governments and international bodies to take
the appropriate steps to minimise health inequity and these root
causes of premature poor health.
5. The WMA and National Medical Associations should encour-
age governments and international bodies to take action on and
implement specific policies and tools addressing health inequity
and the social determinants of health. Some governments have
taken initial steps to reduce health inequity by taking action on
the social determinants of health; local areas have drawn up plans
of action; there are good examples of general practice that work
across sectors improving the quality of people’s lives and hence re-
duce health inequity.The WMA should gather examples of good
practice from its members and promote further work in this area.
WMA Declaration of Ottawa on
Child Health
Adopted by the 50th
World Medical Assembly, Ottawa, Canada, October
1998, Amended by the 60th
WMA General Assembly, New Delhi, India,
October 2009 And by the 71st
WMA General Assembly (online), Cor-
doba, Spain, October 2020
Preamble
Science has now proven that to reach their potential, children need
to grow up in an environment where they can thrive – spiritually,
emotionally, mentally, physically and intellectually. That place must
be characterized by four fundamental elements:
• A healthy,safe and sustainable physical and emotional environment.
• the opportunity for optimal growth and development;
• adequate health services for healthy child development; and
• monitoring and research for evidence-based continual improve-
ment into the future
Physicians know that the future of our world depends on our chil-
dren. Early childhood experiences strongly influence future devel-
opment, including basic learning, school success, economic partici-
pation, social citizenry, and health. In most situations, parents and
caregivers are only able to provide nurturing environments with
help from local, regional, national and international organizations.
The principles of this Declaration apply to all children in the world
from birth to 18 years of age, regardless of race, age, ethnicity, na-
tionality, political affiliation, creed, language, gender, sex, disease or
disability, physical ability, mental ability, sexual orientation, cultural
history, life experience or the socioeconomic status of the child or
her/his parents or legal guardian. In all countries of the world, re-
gardless of resources, meeting these principles should be a prior-
ity for parents, communities and governments. The United Nations
Convention on the Rights of Children (1989) and National Chil-
dren’s rights Charters, set out the broader rights of all children and
young people, but those rights cannot exist without health. Fur-
thermore, the United Nations Sustainable and Development Goals,
especially SDG3, SDG4, SDG5, and SDG6, apply directly to the
health of children and the social determinants of health. Responsi-
bility for giving effect to the principles herein lies with the govern-
ment of the region where the child is primarily domiciled.
All children should be treated with dignity, tolerance and respect
and be taught the same.
All children have the right to the highest attainable standard of
physical and mental health and wellbeing.
Addressing the social determinants of health is essential to achiev-
ing equity in health and healthcare in children.
While children are generally regarded as the vulnerable groups, the
most vulnerable groups of children include children with special
needs, orphans, the homeless, refugees and asylum seekers, disabled,
children from low-income homes and conflict zones. These groups
require special consideration in all areas.
1.
A healthy, safe and sustainable physical and emotional envi-
ronment comprises the following elements:
• A safe and sustainable physical environment with minimum cli-
mate change, optimum ecosystem free from water, air and soil
pollution and degradation;
BACK TO CONTENTS
20
General Assembly Report
• Urgent implementation of climate change adaptation and mitiga-
tion strategies,and age-appropriate education on climate change to
achieve a better and more sustainable environment for all children;
• A safe home, a family setting, available parental care and a com-
munity that cares;
• Healthy, safe and stable families, homes, schools and communi-
ties;
• Protection from bullying and an environment that promotes posi-
tive mental health;
• Protection from discrimination based on age, disease or disability,
creed, ethnic origin, gender, nationality, political affiliation, race,
sexual orientation, social standing or any other factor;
• Access to a safe infrastructure,including safe sanitation,transpor-
tation, and places to play;
• Protection from natural and man-made disasters;
• Protection from physical, sexual, emotional and verbal abuse and
neglect;
• Prevention of exploitation in the form of child labour;
• Protection from harmful traditional practices;
• Freedom from witnessing and participating in violence and armed
conflict including forced recruitment as child soldiers or into gangs;
• Protection from the harms associated with alcohol, tobacco and
substance abuse, including the right to age-appropriate informa-
tion.
All infants should be officially registered within one month of birth
or as soon as possible to enable them to have an official identity,
access to health care, social security and any other resources where
identification is mandatory.
Asylum seeking children, whether accompanied or unaccompanied,
should not be detained,separated from the parents and families sent
back to a place where they are at risk of human rights violations.
2.
The opportunity for optimal growth and development entails:
• Access to adequate healthy and nutritious food to promote long-
term health development. This includes the promotion of exclu-
sive breastfeeding,where possible,for the first six months of life as
long as the mother and baby are comfortable, access to adequate
safe food that satisfies dietary diversity, and protection from obe-
sogenic environments through regulation of unhealthy and pro-
cessed food and beverages;
• Promotion and encouragement of nutritional literacy,physical ac-
tivity and physical education from an early age;
• Access to education from early childhood through secondary
education with provisions for those without access;
• Access to age-appropriate information as it pertains to health, in-
cluding the provision of evidence-based comprehensive sexuality
education;
• Access to social assistance.
3.
Access to the full range or appropriate and high-quality
healthcare services for all stages of childhood development
entails:
The best interests of the child shall be the primary consideration in
the provision of health care.The following principles of child health
care must be ensured:
• Appropriate preventive, curative, rehabilitative and emergency
care for mother and child;
• Prenatal and maternal care for the best possible health at birth
and good postnatal care to ensure the best possible outcomes for
mother and child;
• Respect for the privacy of children;
• Medical care for all children of asylum seekers and refugees;
• Specialized training necessary to enable caregivers to respond ap-
propriately to the specific medical, physical, emotional and devel-
opmental needs of children & their families;
• Basic health care including developmental assessment, health
promotion, recommended immunization, early detection of dis-
ease, access to medicines, oral and eye-health;
• Multidisciplinary (i.e. consisting of physicians, social workers,
psychologists, therapists, occupational therapists, education spe-
cialists and others) and community-based mental health preven-
tion, care and prompt referral for intervention when problems are
identified;
• Priority access to emergency medical care for life-threatening
conditions;
• Hospitalization when appropriate. Hospitals should provide ac-
cess to parental facilities and policies for continuous parental care;
• Specialist diagnosis, care and treatment when needed;
• Rehabilitation services and supports within the community;
• Pain management and care and prevention (or minimization) of
suffering;
• End of life care/Palliative care;
• Informed consent is necessary before initiating any diagnostic,
therapeutic, rehabilitative, or research procedure on a child. In the
majority of cases, the consent shall be obtained from the parent(s)
or legal guardian, or, in some cases, by extended family, although
the wishes of a competent child should be taken into account
before consent is given.  Where a child lacks competence and is
able to express a view, his/her wishes should still be taken into
account before consent is given. Where appropriate (e.g. repro-
ductive health services), competent children should be allowed to
consent to treatment without parental consent. In case of a life-
threatening, and when competent children cannot give consent
and parents/caregivers are not accessible, for treatment, consent
should be presumed for life-saving treatment;
• The full range of sexual and reproductive health services for ado-
lescents including access to abortion according to national legisla-
tion;
BACK TO CONTENTS
21
General Assembly Report
• Respect for the sexual and gender identity of the child. Harmful
practices like genital mutilation or so-called conversion therapies
must be forbidden;
• Social assistance and mechanisms to provide for universal access
to health care are ensured for all particularly vulnerable children;
• The homeless, orphaned, asylum seeker, refugees and children
from conflict zones should be provided with essential and emer-
gency medical care without discrimination.
4.
Monitoring & and research for evidence-based continual im-
provement into the future includes:
• The principles of the Declaration of Helsinki must be observed in
any research study involving children as research subjects.
WMA Declaration
on Pseudoscience and
Pseudotherapies in the Field of
Health
Adopted by the 71st
WMA General Assembly (online), Cordoba, Spain,
October 2020
Definitions
• “Pseudoscience” (false science) refers to the set of statements, as-
sumptions, methods, beliefs or practices that, without following
a valid and recognised scientific method, are falsely presented as
scientific or evidence-based.
• “Pseudotherapies” (false therapies) are those practices intended
for curing diseases, alleviating symptoms or improving health
with procedures, techniques, products or substances based on cri-
teria without the support of available up-to-date scientific evi-
dence; and which may have significant potential risks and harms.
Preamble
Medical practice must be based on the best available up-to-date
scientifically proven evidence.The differences between conventional
medicine and other practices that are not supported by scientific ev-
idence make up the complex universe of pseudosciences and pseu-
dotherapies.
Pseudosciences and pseudotherapies represent a complex system
of theories, assumptions, assertions and methods erroneously re-
garded as scientific, they may cause some patients to perceive a
cause-and-effect relationship between pseudotherapies and the
perception of improvement, hence they may be very dangerous
and are unethical.
There are therapies and techniques accepted by the scientific com-
munity that, used in a complementary manner (such as nutritional,
comfort or wellness, environmental and relaxation therapies, psy-
chotherapeutic support or reinforcement, affectivity and the use of
placebos),provide benefits to the validated main and effective medi-
cal therapy.
Many countries lack the regulatory framework to address these
pseudotherapies, which has allowed their proliferation. In the past,
the medical profession considered them to be harmless due to their
perceived lack of side effects,but nowadays there is enough evidence
to suggest that they can pose a risk to patient safety.
Pseudoscience and Pseudotherapies may have significant potential
risks and harms for various reasons:
• There is a risk that patients abandon effective proved-to-be effec-
tive medical treatments or prevention measures in favour of prac-
tices that have not demonstrated therapeutic value, sometimes
leading to treatment failure for critical conditions that may even
lead to death.
• There are frequent likelihood of dangerous delays and loss of op-
portunity in the application of medicines, procedures and tech-
niques recognised and endorsed by the scientific medical com-
munity as evidence-based effective interventions.
• They may cause patients to suffer financial damages psychologi-
cal-physical traumas, and go against the dignity of people, threat-
ening their moral integrity.
• Unproven therapies may contribute to the rising costs of health-
care procedures.
All new diagnostic, preventive and therapeutic methods should be
tested in accordance with scientific methods and ethical principles
in order to assess their safety, efficiency, efficacy and scope of ap-
plication.
A physician’s duty is to provide quality medical care to all patients
based on best available scientific evidence, as referred in the WMA
Declaration of Geneva and the International Code of Medical Eth-
ics commending the highest ethical norms and quality care for the
safety of the patient. The interest of the patient must be placed be-
fore any other interest, including the physician’s own.
The WMA reaffirms its Lisbon Declaration on Patient Rights and
recalls that Patient Safety requires addressing all opportunities for
the patient to receive appropriate, evidence-based care.
BACK TO CONTENTS
22
General Assembly Report
Recommendations
Thus, the WMA makes the following recommendations:
National Health Authorities
1. Appropriate and rigorous regulation commensurate with best
practices is necessary to address the risks and reduce the po-
tential harms arising from pseudotherapies and pseudoscience.
2. National authorities and healthcare systems should decline ap-
proval of and reimbursement of costs providing pseudothera-
pies.
3. In collaboration with professional medical organisations, sci-
entific societies and patients’ associations, national authorities
should develop public campaign raising awareness on the risk of
pseudotherapies and pseudosciences.
WMA Constituent members and the medical profession
4. WMA constituent members and the medical profession must
recognize and be aware of the risks of pseudotherapies and
pseudosciences.
5. Pseudotherapies and pseudosciences should not be regarded
as medical specialties recognized by the scientific community
and legally endorsed as a specialist or sub-specialist pseudo-
science.
6. All acts of professional intrusion , pseudoscience and pseudo-
therapy activities that put public health at risk must be reported
to the competent authorities, including misleading advertising
and unaccredited healthcare websites that offer services and/or
products and that put the health of patients at risk, yet patient
confidentiality has to be respected. The role of the general and
specialized media for transparency and truthfulness in increas-
ing critical public scientific awareness is essential.
7. Constituent members should work with governments to es-
tablish the highest level of protection for patients treated with
pseudotherapies/pseudosciences. When such a practice is found
to be harmful or unethical to apply, there should be a system
in place to either immediately stop or substantially restrict any
given treatment classified as complementary and/or alternative
in order to protect public health.
Physicians
8. With the support of the relevant organisations and authorities
involved in the governance and regulation of the medical profes-
sion, physicians must continue to practice medicine as a service
based on the application of critical scientific current knowledge,
specialist skills and ethical behaviour and to maintain their skills
up to date on developments in their professional field.
9. For the patient’s safety and quality of care, the physician must
have the freedom to prescribe, while respecting scientific evi-
dence and the standard of care.
10. The patient must be kept duly informed about the available
therapy options, their effectiveness and risks, and be able to
participate in the best therapeutic decision-making. Good com-
munication, mutual trust and person-centered healthcare are
cornerstones of the physician-patient relationship. Patients and
physicians should and must be able to discuss the risks of pseu-
doscience and pseudotherapies. Health education is fundamen-
tal.
11. Physicians should be educated to identify pseudoscience/pseu-
dotherapies, logical fallacies, and cognitive biases and counsel
their patients accordingly. They should be aware that some pa-
tient groups, such as patients with cancer, psychiatric illnesses
or serious chronic diseases, as well as children, are particularly
vulnerable to the risks associated with using pseudotherapies.
12. When obtaining the patient’s history (anamnesis), the physi-
cian should inquire about all therapeutic measures (proven or
otherwise) the patient has been exposed or is still exposed to. If
necessary, the physician should inform the patient on potential
harms associated with the previous use of Pseudotherapies and
pseudosciences.
13. The physician must inform the patient that complementary
treatment is not a therapeutic alternative or substitute for a vali-
dated main medical treatment.
Note: The aim of this declaration is not the traditional ancestral medi-
cines nor the so-called indigenous medicines, firmly rooted in peoples and
nations, forming an intrinsic part of their culture, rites, traditions and
history.
WMA Resolution in Support
of an International Day of the
Medical Profession, October 30
Adopted by the 71st
WMA General Assembly (online), Cordoba, Spain,
October 2020
On the eve of the WMA General Assembly, Córdoba 2020, we are
facing an escalation of the COVID-19 pandemic around the world
and an alarming exponential pressure on healthcare professionals.
The WMA and its members request that October 30 be recognised
as the International Day of the Medical Profession as a tribute to
the commitment of physicians to the service of humankind, to the
health and well-being of their patients, in the respect the ethical
values of the profession.
BACK TO CONTENTS
23
General Assembly Report
WMA Resolution in Support of
Dr. Serdar Küni
Adopted by the 206th
WMA Council Session, Livingstone, April 2017
and reaffirmed as a Resolution by the 71st
WMA General Assembly (on-
line), Cordoba, Spain, October 2020
The World Medical Association notes with serious concerns that
Dr Serdar Küni, the Human Rights Foundation of Turkey’s rep-
resentative in Cizre and former president of the Şırnak medical
chamber, is still imprisoned after 6 months of detention, on charges
that he provided medical treatment to alleged members of Kurdish
armed groups.
The case of Dr. Küni is one example amongst many of ongoing ar-
rests, detentions, and dismissals of physicians and other health pro-
fessionals in Turkey since July 2015, when unrest broke out in the
southeast.
The WMA condemns such practices that threaten gravely the safety
of physicians and the provision of health-care services. The protec-
tion of health professionals is fundamental, so that they can fulfil
their duties to provide care for those in need, without regard to any
element of identity, affiliation, or political opinion.
The WMA recalls the standards of international human rights law,
specifically the Universal Declaration of Human Rights (1948)
and the International Covenants on Civil and Political Rights and
on Economic, Social and Cultural Rights (1966) ratified by Turkey.
The Covenant on Economic, Social and Cultural Rights guaran-
tees in its article 12 “the right of everyone to the enjoyment of
the highest attainable standard of physical and mental health”.This
implies ensuring access to high quality healthcare, supported by a
functioning healthcare system and safe conditions for the health
workforce.
The WMA recalls as well the standards of international humanitar-
ian law as well as the UN Security Council Resolution S/RES/2286 on
Health Care in Armed Conflict that mandates that states should not
punish medical personnel for carrying out medical activities com-
patible with medical ethics, or compel them to undertake actions
that contravene these standards.
Furthermore, the WMA reaffirms the principles of medical ethics,
including the WMA Regulations inTimes of Armed Conflict and Other
Situations of Violence as well as the Ethical Principles of Health Care
in Times of Armed Conflict and Other Emergencies endorsed by the
ICRC, civilian and military health-care organisations.
The WMA considers that punishing a physician for providing care
to a patient constitutes a flagrant breach of international humani-
tarian and human rights standards as well as medical ethics. Ulti-
mately it contravenes to the principle of humanity that includes the
imperative to preserve human dignity.
Thus, in view of the next hearing on 24 April regarding Dr. Küni
case at the Şırnak 2nd
Heavy Penal Court, the WMA urges national
medical associations and the international health community to
mobilise in support of the immediate release of Dr. Serdar Küni and
the charges based on his medical practice be dropped immediately
and unconditionally.
The WMA calls as well national medical associations and the inter-
national health community to advocate for:
• The full respect of Turkey’s humanitarian and human rights obli-
gations, including the right to health, freedom of association and
expression as well as the access to a fair trial;
• The provision of effective remedy and reparation to victims of ar-
bitrary arrests and detentions.
WMA Resolution in Support
to the Turkish Medical
Association
Adopted by the 71st
WMA General Assembly (online), Cordoba, Spain,
October 2020
The WMA and its members are deeply concerned by the recent
Turkish governmental announcement to dismantle the Turkish
Medical Association as a national professional organisation, alleg-
edly to “protect patients and the profession from terrorists”.
The Turkish Medical Association is a dedicated member of the
WMA, recognised for its commitment to serve public health in-
terests, to protect patients and physicians with respect of the ethical
values of the profession.
The WMA considers that qualifying the thousand physicians’mem-
bers of the Turkish Medical Association as terrorists constitutes a
grave defamation and an insult to the entire profession.
Recalling its Resolution on the Independence of National Medical As-
sociations, the WMA opposes such governmental interference with
the independent functioning of a national medical association and
BACK TO CONTENTS
24
General Assembly Report
urges the government of Turkey and the members of the parliament
to:
1. Protect the establishment of the Turkish Medical Association
as a national independent association and main representative
of all physicians in the country, and prevent any legal regulation
that will harm its professional autonomy;
2. Respect the universal professional values of medicine, which
were built upon thousands of years of experience and aim to
prioritise patient and public health;
3. Comply fully with international human rights instruments that
Turkey is a State Party to.
WMA Resolution on Equitable
Global Distribution of Covid-19
Vaccine
Adopted by the 71st
WMA General Assembly (online), Cordoba, Spain,
October 2020
Preamble
The SARS-CoV-2 pandemic has a tight grip on the world. Over a
million people have died worldwide and millions more are still suf-
fering the effects of this virus and the disease it causes.
A vaccine is widely seen as the best way to stop the spread of the
virus, gain control of the pandemic and save human lives.
WMA policy clearly states that “vaccination and immunisation have
been acknowledged as an effective and safe preventive strategy for
several communicable diseases. And vaccine development and ad-
ministration have been the most significant intervention to eradicate
infectious diseases and influence global health in modern times”.
While there are currently no approved vaccines for COVID-19, an
unprecedented global effort is underway, both in terms of scale and
speed, to develop a safe and effective vaccine and to optimise pro-
curement and distribution to ensure that all regions of the world
stand to benefit as quickly as possible. Some current predictions
anticipate an initial COVID-19 vaccine rollout in the first half of
2021. Due to intensive efforts to produce effective vaccines and fast
track them for market authorisation, many clinical trials have been
placed on extremely accelerated schedules. Processes usually requir-
ing years are being condensed into months, which could potentially
pose a threat to the ethical principles outlined in the WMA Decla-
ration of Helsinki.
Questions arose quite early in the pandemic about how to distribute
a potential new vaccine quickly and equitably. Many higher-income
countries have already signed bilateral agreements with pharma-
ceutical companies to supply or distribute COVID-19 vaccine can-
didates, which, given the limitations on production capacity, could
leave developing countries at a disadvantage as they strive to protect
their populations.
It is a fact that a pandemic cannot be contained by one country
alone; it requires a collaborative,global effort, as the WMA has out-
lined in its Statement on Epidemics and Pandemics and the State-
ment on Avian and Pandemic Influenza.
In the same spirit, GAVI, the Vaccine Alliance, the Coalition for
Epidemic Preparedness Innovations (CEPI) and the World Health
Organization (WHO) have initiated the COVAX platform in or-
der to guarantee that all participating countries, regardless of their
income, have equal access to new COVID-19 vaccines once they
are developed.
Recommendations
The World Medical Association
1. welcomes multilateral solutions in the global battle against
­
COVID-19, in particular the COVAX platform, for ensuring
equitable, global distribution of a safe and effective COVID-19
vaccine;
2. emphasises that no country should be left behind in the race to
vaccinate its population against this global threat;
3. stresses the need to balance between the desire of each country
to protect its citizens and the need for the vaccine to be distrib-
uted worldwide;
4. reiterates that all clinical trials must follow the ethical principles
for medical research involving human subjects as set forth in the
WMA Declaration of Helsinki;
5. states that longer-term, formal safety monitoring is necessary
in cases where clinical trials have been accelerated to fast track
vaccines for market authorisation;
6. calls attention to the heightened risk faced by health workers
and vulnerable populations in a pandemic situation and there-
fore urges that these individuals be among the first to receive a
safe and effective vaccine;
7. renews its call to all constituent members to increase awareness
of immunisation schedules and calls upon individual physicians
to pay special attention to addressing the concerns of vaccine-
hesitant patients;
BACK TO CONTENTS
25
General Assembly Report
8. reaffirms its warning on vaccine hesitancy (April 2019) and re-
iterates the importance of maintaining other important routine
vaccinations, e.g. against polio, measles and influenza;
9. calls for coordinated efforts to increase public trust in vaccination
in the face of disinformation campaigns and anti-vaccine move-
ments which undermine the health of both children and adults.
WMA Resolution on Human
Rights Violations Against Uighur
People in China
Adopted by the 71st
WMA General Assembly (online), Cordoba, Spain,
October 2020
Preamble
It is incumbent upon health professionals to consider the health
and human rights of people globally and denounce instances where
these rights are being abused.The treatment of the Uighur people in
the Xinjiang region of China is one such case.
Documented reports of physical and sexual abuse of Uighur people
in China reveal unequivocal human rights violations. Reports note
numerous violations of the Universal Declaration of Human Rights.
The transgressions include, but are not limited to:
• Article 5: No one shall be subjected to torture or to cruel, inhu-
man or degrading treatment or punishment.
• Article 9: No one shall be subjected to arbitrary arrest, detention
or exile.
• Article 25 (i): Everyone has the right to a standard of living ad-
equate for the health and well-being of himself and of his family,
including food, clothing, housing and medical care and necessary
social services, and the right to security in the event of unem-
ployment, sickness, disability, widowhood, old age or other lack of
livelihood in circumstances beyond his control.*
Human rights organisations and sovereign states are increasingly
drawing attention to the situation in Xinjiang, with over 20 United
Nations ambassadors taking the rare step of issuing a joint letter to
the UN Human Rights Council in 2019 expressing concerns about
the treatment of the Uighurs in China and demanding that interna-
tional independent observers be allowed into the region.
*  https://www.un.org/en/universal-declaration-human-rights/
Recommendations
In the light of information and reports of systematic and repeated
human rights violations against Uighur people in China, and its
impact on the health of the Uighur people and health care supplies
throughout the world, the WMA calls on its constituent members,
physicians and the international health community to:
1. formally condemn the treatment of the Uighurs in China’s Xin-
jiang region and call upon physicians to uphold the guidelines
set out in the WMA Declaration of Tokyo and the WMA Resolu-
tion on the Responsibility of Physicians in the Documentation and
Denunciation of Acts of Torture or Cruel or Inhuman or Degrading
Treatment;
2. support the requests made in the July 2019 letter to the UN
Human Rights Council High Commissioner calling for inter-
national independent observers to be allowed into the Xinjiang
region of China.
3. Reaffirm its Statement on Forced and Coerced Sterilisation, as-
serting that no person, regardless of gender, ethnicity, socio-
economic status, medical condition or disability, should be
subjected to forced or coerced permanent sterilisation, and call
on its members medical associations to advocate against forced
and coerced sterilisation in their own countries and globally;
and
4. Reiterate support of its Declaration on Fair Trade in Medical
Products and Devices and urge its medical association members
to promote fair and ethical trade in the health sector, and insist
that the goods they use are not produced at the expense of the
health of workers in the global community. To do this, physi-
cians should;
–
– raise awareness of the issue of ethical trade and promote the
development of fair and ethically produced medical goods
amongst colleagues and those working within health sys-
tems.
–
– play a leadership role in integrating considerations of labour
standards into purchasing decisions within healthcare organ-
isations.
BACK TO CONTENTS
26
General Assembly Report
WMA Resolution on Protecting
the Future Generation’s Right to
Live in a Healthy Environment
Adopted by the 71st
WMA General Assembly (online), Cordoba, Spain,
October 2020
Preamble
Exponential increase in the number of climate change related fires,
hurricanes, ice meltdowns, heat waves and deforestation, especially
of the rainforests, show that there is no time to waste. There is an
urgent need to accelerate the efforts that will trigger the changes to
be implemented by international and national policy and decision
makers in order to stop as well as to adapt to the climate crisis.
Climate change and air pollution are closely connected, both have
huge impacts on human health and result from anthropogenic
emissions due to the combustion of fossil fuels. As it is mentioned
by international bodies such as Clean Air Initiative founded by the
UN, the World Health Organization (WHO), the UN Environ-
ment Programme (UNEP) and the Climate and Clean Air Coali-
tion (CCAC); all governments, researchers and non-governmental
organisations should urgently start to tackle the air pollution and
climate crisis together.
Considering the urgency and complexity of climate change, it is
needed to create a global change to stop the causes of this crisis.
Therefore, WMA calls on international, national, regional or pro-
vincial decision makers such as politicians, policy makers and judges
to recognize the urgency, complexity, and interconnectedness of the
essence of the climate crisis action and to take immediate action in
order to protect the rights of future generations for the sake of cli-
mate justice.
Climate crisis causes a serious loss,damage or destruction of ecosys-
tems and cultural damage, which has severe impacts on all inhabit-
ants of the world. In order to ensure the right to live for the future
generations, there is an imminent need for binding legal measures
to be adopted and implemented at the national and international
arena against the polluters causing emissions that cause especially
climate crisis as well as air, water and soil pollution.
Health professionals have a duty to care, respect and protect the
human life, as well as the right to live for future generations and all
forms of the natural living world. WMA believes that all people,
including future generations, have the right to the environmental,
economic and social resources needed for healthy and produc-
tive lives; such as clean air, soil, water and food security. Therefore;
WMA has a historical responsibility of acting proactively in order
to initiate the necessary changes and solutions to struggle with the
climate crisis.
Recommendations
WMA proposes the following recommendations to its members
and other related organizations:
1. Urge to ask its members to collaborate with relevant bodies in
their countries in order to raise awareness about the necessity
for legally binding sanctions and policies at the national and
international level for the polluters that threaten the right to live
for the future generations by emitting gases which are proven to
cause climate crisis and air, soil and water pollution.
2. Urge all national governments, policy makers, researchers and
health professionals to mobilize in order to develop and imple-
ment comprehensive policies to struggle with the problems due
to the use of fossil fuels by industry as well as the individuals that
lead to problems such as climate crisis air,water and soil pollution.
3. Urge all medical professionals, media, governmental and non –
governmental institutions to refer climate change as ‘climate cri-
sis’ and calls the leaders of national, state or provincial, regional,
city, and local governments to declare a climate emergency in
order to initiate a society-wide action. Moreover, encourage the
media to promote the concept and meaning of the right to live
for future generations.
4. Update the curriculum at medical schools and add compulsory
sections on environmental health in order to educate health
professionals that are able to think critically about the health
impacts of the environmental problems, are aware of the rea-
sons, impacts/dimensions of the climate crisis and able to of-
fer solutions designed to protect the rights and health of future
generations.
5. Advocate and organize interdisiplinary campaigns in order to
stop the new permissions from being given to the industrial fa-
cilities using fossil fuels that cause climate crisis and pollution.
6. Urge national governments and international bodies such as
WHO to adopt stricter regulations on environmental protection
and evaluation, permission, monitoring and control procedures
of new industrial facilities to limit the health impact resulting
from their emissions.
7. Advocate actively for policies that will maximize health benefits
by reducing air pollutants (such as ground ozone and particulate
matter etc.) and carbon emissions,increase walking,cycling, and
use of public transport, and consumption of nutritious, plant-
rich diets to ensure climate justice. Urge international, national,
BACK TO CONTENTS
27
General Assembly Report
state or provincial, regional, city, and local governments to adopt
and implement air quality and climate change policies that will
achieve the WHO Ambient Air Quality Guideline values.
8. Urge national, state or provincial, regional, city, and local gov-
ernments through public campaigns and advocacy to cut subsi-
dies given to fossil fuel industries and to direct these subsidies to
support just transition, energy efficiency measures, green energy
resources and public welfare.
9. Urge governments and private sector to invest in policies that
support a just transition for workers and communities adversely
impacted by the move to a low-carbon economy and to build so-
cial protection through investment in and transition to green jobs.
10. Urge national, state or provincial, regional, city, and local gov-
ernments to act on other causes of climate crisis such as in-
dustrial agriculture,animal husbandry and deforestation,to pro-
mote legal trade and financing policies that prioritize and enable
sustainable agro-ecological practices, end deforestation for the
expansion of industrial agriculture and to reduce reliance on in-
dustrial animal-based agriculture and environmentally damag-
ing agricultural and fisheries practices.
11. Urge national,state or provincial,regional,city,and local govern-
ments to invest in human capacity and knowledge infrastructure
to spread regenerative agriculture solutions that can produce the
change needed while providing myriad co-benefits to farmers
and consumers, providing a global support network  – on the
ground – for farmers and capturing carbon in the soil.Emphasize
building resilient and regenerative local food systems that can
reduce carbon emissions, support the livelihoods of agricultural
communities and provide food security for future generations.
12. Urge national governments, together with the involvement of
health sector, to develop national adaptation plans and to con-
duct national assessments of climate crisis impacts,vulnerability,
and adaptation for health.
WMA Resolution on the Access
to Adequate Pain Treatment
Adopted by the 62nd
WMA General Assembly, Montevideo, Uruguay,
October 2011 And amended by the 71st
WMA General Assembly (on-
line), Cordoba, Spain, October 2020
Preamble
Around the world, tens of millions of people with cancer and
other diseases and conditions experience moderate to severe pain
without access to adequate treatment. These people face severe
suffering, often for months on end, and many eventually die in
pain.Those who may not be able to adequately express their pain –
such as children, people with intellectual disabilities and those
with altered consciousness– and individuals and populations that
have historically been undertreated for pain and pain management
due to bias, are especially at risk of receiving inadequate pain treat-
ment.
Inadequate pain treatment contributes to individual suffering physi-
cally and emotionally, but also causes huge care burdens and nega-
tive economic impact on a national level.
However, most of the suffering is unnecessary and is almost always
preventable and treatable.
In most cases, pain can be stopped or relieved with inexpensive and
relatively simple treatment interventions, which can dramatically
improve the quality of life for patients. Sometimes, especially in se-
vere chronic pain, psycho-emotional factors are even more signifi-
cant than physiologic factors.
Pain treatment in these cases may require a multi-faceted approach
to care by multidisciplinary teams.
Over the years, the use of opioids has seen significant growth in
some countries. In many other areas around the world, however, ac-
cess to essential pain treatment remains limited for patients in pain.
Even in countries with a high volume of use, it can be difficult for
specific populations to receive adequate treatment for their pain.In-
complete pain assessment or improper use of pain medication can
bring about adverse drug reactions. All of these are very important
and urgent issues need to be addressed.
Governments should adopt effective measures, wherever possible,
for adequate pain treatment. For this goal, governments shall en-
sure that healthcare professionals across fields are entitled to educa-
tional training on pain evaluation and management; that the right
of all patients in pain to pain treatment is not compromised due to
unnecessary regulations; and that policies on the management of
controlled drugs help with effective monitoring of and prevention
against risks associated with controlled drugs.
Recommendations
1. Access to adequate pain treatment is a human right. Physicians,
medical professionals and health care workers must offer pain
assessment and pain treatment to patients with pain. Govern-
ments must provide sufficient resources and proper pain treat-
ment regulations.
BACK TO CONTENTS
28
General Assembly Report
2. Pain is a complex perception consisting of physical, psychologi-
cal, social, cultural and spiritual sufferings. Physicians, medical
professionals and health care workers must offer holistic pain as-
sessment and appropriate pain treatment, such as pharmacolog-
ical and/or non-pharmacological interventions to patients with
pain. All healthcare professionals should seek to fulfill the goal
of effectively evaluating the pain of all patients, including pain
suffered by children, cognitively impaired patients and those
unable to properly express themselves. Healthcare professionals
should also seek to effectively evaluate and treat pain in patients
and populations who have historically been undertreated for
pain due to implicit and explicit biases.
3. Pain treatment and control education shall be provided to
healthcare professionals including physicians, other medical
professionals, and other health care workers.
Education should include pain assessment, evidence-based pain
control, and the efficacy and risks of painkillers. Education should
include pain medicine, including the action of opioids, preventing
adverse reactions, and the adjustment and conversion of the dosage
of opioids. Patient-centered care should be taught to fulfill the goal
of adequately stopping pain and reducing the incidence of adverse
reactions. The curriculum shall be highly competence-based in de-
sign enhancing the knowledge, the attitude, and the skills of health-
care professionals while treating pain.
Education should support the development of pain and palliative
specialists, in order for them to effectively support first-line physi-
cians and other medical professionals.
Pain treatment education for medical professionals shall include the
non-medicinal treatment options. Education should equip medical
professionals with proper interpersonal communication skills, cul-
tural sensitivity, and the ability to evaluate the overall pain suffered
by patients at the physiological, psychological, and spiritual levels
and to empower them in inter-professional practice so that profes-
sionals can work together to alleviate the pain felt by patients with
and without medication.
4. Governments, regulators and healthcare administrators must ac-
knowledge the consequences of pain in terms of health,productiv-
ity, and economic burden. Governments should provide ample re-
sources and have suitable regulations governing controlled drugs.
For policies on the control of drugs, governments shall periodically
review and adequately revise them to ensure the availability and ac-
cessibility of controlled drugs such as opioids.In addition,abuse and
illicit use must be prevented.
• Patients in pain shall be given access to effective pain medication,
including opioids. Depriving them of such right is a violation of
their right to health and is medically unethical.
• Governments must ensure that controlled drugs, including opi-
oids, are made available and accessible to help relieve the suffer-
ing. Relief of suffering and prevention against abuse shall be bal-
anced in the management of controlled drugs.
Government shall provide abundant resources and create a national
pain management research institute to explore issues in pain treat-
ment and to come up with solutions, in particular:
• Explore issues that become barriers to pain treatment, such as fi-
nancial condition, socioeconomic status, patient race and ethnic-
ity, urban and rural differences, logistics, insufficient training, and
culture (the misunderstanding that people have about opioids, for
example)
• Promote the use of validated pain assessment tools.
• Conduct studies of emerging therapies or non-medicinal thera-
pies.
• Establish a system and a standard procedure to record and col-
lect pain-related data for correct statistics and monitoring. Pain-
related data includes the incidence and prevalence of pain, cause
of pain, burden of pain, pain treatment status, reason for pain not
properly treated, and number of people with drug abuse, etc.
5. Governments shall prepare a national pain treatment plan to be
followed in pain prevention, pain treatment, pain education, and
policies on the management of controlled drugs.
–
– The national pain treatment plan shall be evidence-based.
–
– Governments must take into consideration opinions of policy-
makers, medical professionals, and the general public in order
to prepare a national pain treatment plan that is extensive,prac-
tical, and forward-looking, contributing to enhanced nation-
wide pain treatment efficacy.
WMA Resolution on the
Responsibility of Physicians
in the Documentation and
Denunciation of Acts of
Torture or Cruel or Inhuman or
Degrading Treatment
Adopted by the 54th
WMA General Assembly, Helsinki, Finland, Sep-
tember 2003, revised by the 58th
WMA General Assembly, Copenhagen,
Denmark, October 2007 and by the 71st
WMA General Assembly (on-
line), Cordoba, Spain, October 2020
BACK TO CONTENTS
29
General Assembly Report
Preamble
The dignity and value of every human being are acknowledged
globally and expressed in numerous distinguished ethical codes and
codifications of human rights, including the Universal Declaration
of Human Rights. Any act of torture or cruel, inhuman or degrad-
ing treatment constitutes a violation of these codes and is irreconcil-
able with the ethical principles that lie at their core.These codes are
listed at the end of this Statement (1).
However, in the medical professional codes and legal texts, there
is no consistent and explicit reference to an obligation upon phy-
sicians to document cases and denounce acts of torture or cruel,
inhuman or degrading treatment of which they become aware or
witness.
The careful and consistent documentation and denunciation of tor-
ture or cruel, inhuman or degrading treatment by physicians con-
tributes to the human rights of the victims and to the protection of
their physical and mental integrity. The absence of documentation
and denunciation of these acts may be considered as a form of toler-
ance thereof.
Because of the psychological sequelae from which they suffer, or the
pressures brought upon them, victims are often unable or unwilling
to formulate by themselves complaints against those responsible for
the torture or cruel, inhuman and degrading treatment and punish-
ments they have undergone.
By ascertaining the sequelae and treating the victims of torture, ei-
ther early or late after the event, physicians witness the effects of
these violations of human rights.
The WMA recognizes that in some circumstances, documenting
and denouncing acts of torture may put the physician, and those
close to him or her, at great risk. Consequently, doing so may have
excessive personal consequences.
This statement relates to torture and other cruel, inhuman and de-
grading treatment and punishments as referred by the United Na-
tions Convention against torture, excluding purposely the role of
physicians in detention appraisal addressed in particular by the UN
Standard Minimum Rules for the Treatment of Prisoners (Mandela
rules).
Recommendations
The WMA recommends that its constituent members:
1. Promote awareness among physicians of The Istanbul Protocol,
including its Principles on the Effective Investigation and Doc-
umentation of Torture and Other Cruel,Inhuman or Degrading
Treatment.This should be done at the national level.
2. Promote training of physicians on the identification of differ-
ent methods of torture and cruel, inhuman and degrading treat-
ment and punishments, to enable them to provide high quality
medical documentation that can be used as evidence in legal or
administrative proceedings.
3. Encourage professional training to ensure that physicians in-
clude assessment and documentation of signs and symptoms of
torture or cruel, inhuman and degrading treatment and punish-
ments in the medical records, including the correlation between
the allegations given and the clinical findings.
4. Work to ensure that physicians carefully balance potential
conflicts between their ethical obligation to document and de-
nounce acts of torture or cruel, inhuman and degrading treat-
ment and punishments and a patient’s right to informed consent
before documenting torture cases.
5. Work to ensure that physicians avoid putting individuals in
danger while assessing, documenting or reporting signs of tor-
ture and cruel, inhuman and degrading treatment and punish-
ments.
6. Promote access to immediate and independent health care for
victims of torture or cruel, inhuman and degrading treatment
and punishments.
7. Support the adoption of ethical rules and legislative provi-
sions:
–
– Aimed at affirming the ethical obligation on physicians to re-
port and denounce acts of torture or cruel, inhuman and de-
grading treatment and punishments of which they become
aware; depending on the circumstances, the report or denun-
ciation should be addressed to the competent national or inter-
national authorities for further investigation.
–
– Addressing that a physician’s obligation to document and de-
nounce instances of torture and cruel, inhuman and degrading
treatment and punishments may conflict with their obligations
to respect patient confidentiality and autonomy.
–
– Physicians should use their discretion in this matter, bearing in
mind paragraph 69 of the Istanbul Protocol (2).
–
– cautioning physicians to avoid putting in danger victims who
are deprived of freedom,subjected to constraint or threat or in a
compromised psychological situation when disclosing informa-
tion that can identify them.
–
– Work to ensure protection of physicians, who risk reprisals or
sanctions of any kind due to the compliance with these guide-
lines.
–
– Provide physicians with all relevant information on procedures
and requirements for reporting torture or cruel, inhuman and
degrading treatment and punishments, particularly to national
authorities, non-governmental organizations and the Interna-
tional Criminal Court.
BACK TO CONTENTS
30
General Assembly Report
8. The WMA recommends that the constituent members’codes of
ethics include the physician’s obligations concerning documen-
tation and denunciation of acts of torture and cruel, inhuman
and degrading treatment and punishments as they are stated in
this document.
(1) Codes and codifications:
1. The Preamble to the United Nations Charter of 26 June 1945
solemnly proclaiming the faith of the people of the United Na-
tions in the fundamental human rights, the dignity and value of
the human person.
2. The Preamble to the Universal Declaration of Human Rights
of 10 December 1948 which states that disregard and contempt
for human rights have resulted in barbarous acts which have
outraged the conscience of mankind.
3. Article 5 of the Universal Declaration of Human Rights which
proclaims that no one shall be subjected to torture or cruel, in-
human or degrading treatment.
4. The United Nations Standard Minimum Rules for the Treat-
ment of Prisoners (the Nelson Mandela Rules), Adopted by the
First United Nations Congress on the Prevention of Crime and
the Treatment of Offenders, held at Geneva in 1955, and ap-
proved by the Economic and Social Council by its resolutions
663 C (XXIV) of 31 July 1957 and 2076 (LXII) of 13 May
1977, revised and adopted by the General Assembly on 17 De-
cember 2015.
5. The American Convention on Human Rights, which was ad-
opted by the Organization of American States on 22 November
1969 and entered into force on 18 July 1978, and the Inter-
American Convention to Prevent and Punish Torture, which
entered into force on 28 February 1987.
6. The Declaration of Tokyo, Adopted by the 29th
World Medical
Assembly,Tokyo,Japan,October 1975 Editorially revised by the
170th
WMA Council Session, Divonne-les-Bains, France, May
2005 and the 173rd
WMA Council Session, Divonne-les-Bains,
France, May 2006. Revised by the 67th
WMA General Assem-
bly,Taipei,Taiwan, October 2017.
7. The Declaration of Hawaii, adopted by the World Psychiatric
Association in 1977.
8. The Principles of Medical Ethics Relevant to the Role of
Health Personnel, Particularly Physicians, in the Protection
of Prisoners and Detainees Against Torture and Other Cruel,
Inhuman or Degrading Treatment or Punishment, adopted by
the United Nations General Assembly on 18 December 1982,
and particularly Principle 2, which states: “It is a gross con-
travention of medical ethics… for health personnel, particu-
larly physicians, to engage, actively or passively, in acts which
constitute participation in, complicity in, incitement to or at-
tempts to commit torture or other cruel, inhuman or degrad-
ing treatment…”.
9. The Convention Against Torture and Other Cruel, Inhuman
or Degrading Treatment or Punishment, which was adopted by
the United Nations General Assembly on December 1984 and
entered into force on 26 June,1987.
10. The European Convention for the Prevention of Torture and
Inhuman or Degrading Treatment or Punishment, which was
adopted by the Council of Europe on 26 June 1987 and entered
into force on 1 February 1989.
11. The WMA Declaration of Hamburg, adopted by the World
Medical Association in November 1997 during the 49th
Gen-
eral Assembly, and reaffirmed with minor revision by the 207th
WMA Council session, Chicago, United States, October 2017
calling on physicians to protest individually against ill-treat-
ment and on national and international medical organizations
to support physicians in such actions.
12. The Istanbul Protocol (Manual on the Effective Investigation
and Documentation of Torture and Other Cruel, Inhuman or
Degrading Treatment or Punishment), adopted by the United
Nations General Assembly on 4 December 2000.
13. The Convention on the Rights of the Child, which was adopted
by the United Nations on 20 November 1989 and entered into
force on 2 September 1990.
14. The World Medical Association Declaration of Malta on Hun-
ger Strikers, adopted by the 43rd
World Medical Assembly
Malta, November 1991and amended by the WMA General
Assembly, Pilanesberg, South Africa, October 2006, and revised
by the 68th
WMA General Assembly, Chicago, United States,
October 2017.
(2) Istanbul Protocol, paragraph 69.
“In some cases, two ethical obligations are in conflict. Interna-
tional codes and ethical principles require the reporting of infor-
mation concerning torture or maltreatment to a responsible body.
In some jurisdictions, this is also a legal requirement. In some
cases, however, patients may refuse to give consent to being exam-
ined for such purposes or to having the information gained from
examination disclosed to others. They may be fearful of the risks
of reprisals for themselves or their families. In such situations,
health professionals have dual responsibilities: to the patient and
to society at large, which has an interest in ensuring that justice
is done and perpetrators of abuse are brought to justice. The fun-
damental principle of avoiding harm must feature prominently in
consideration of such dilemmas. Health professionals should seek
solutions that promote justice without breaking the individual’s
right to confidentiality. Advice should be sought from reliable
agencies; in some cases, this may be the national medical associa-
tion or non-governmental agencies. Alternatively, with supportive
encouragement, some reluctant patients may agree to disclosure
within agreed parameters.”
BACK TO CONTENTS
31
General Assembly Report
WMA Resolution Regarding
the Medical Profession and
Covid-19
Adopted by the 71st
WMA General Assembly (online), Cordoba, Spain,
October 2020
Preamble
The current COVID-19 pandemic is causing one of the greatest
challenges that healthcare professionals have ever faced in recent
decades. According to the World Health Organization (WHO),
COVID-19 has exposed healthcare professionals and their social
and family environment to unprecedented levels of risk. Although
not representative, data from many countries across all regions in-
dicate that the number of SARS CoV-2 virus infections among
healthcare professionals has reached alarming numbers for any
healthcare system.
The constant risk of infection and, in many cases, the lack of ade-
quate material and human resources,the high number of infected,the
physicians’ morbidity and mortality and the lack of human resources
policies is causing a physical and emotional exhaustion among health
professionals. Moreover, thousands of physicians are losing their lives
practicing their profession and fulfilling their ethical duties,a number
that is increasing as the pandemic advances in most countries.
As a result of this global situation, the WMA offered its support to
the World Health Professions Alliance open letter which calls on immedi-
ate G20 action to secure personal protective equipment for health person-
nel dated April 9,2020,and denounced it through its Urgent Call for
governments to support healthcare staff in the battle against Covid-19
on April 2, 2020.
The derived consequences that the pandemic will cause in the polit-
ical, economic and social spheres in all countries should be added to
this situation. All of this will worsen the global population’s health
and will require an effort and commitment from the medical profes-
sion, its National Medical Associations and the WMA.
Recommendations
The WMA wants to recognise the fight of the medical profession
against the pandemic through this Urgent Resolution and advocates
to:
1. Sufficient provision of equipment and personal protection ma-
terial (PPE) for health professionals, which allows healthcare
and guarantees the availability of this material in a situation of
possible outbreaks.
2. Urge governments to adopt a multilateral and coordinated ap-
proach on a global scale of the crisis to promote equality in inter-
ventions, access to health services, treatments and future vaccines.
3. Provide enough financing to healthcare systems so that they
can face the costs of the pandemic and guarantee accessible and
quality healthcare.
4. The National Medical Associations and the WMA encourage
an active participation in the planning and management of all
stages of the response to the epidemic.
5. Recognise that SARS CoV-2 infection be recognised as an oc-
cupational disease and that the medical profession be declared
a “profession at risk”. Likewise, we request that taking care of
healthcare professionals be a priority, especially in the field of
mental health.
6. Fight against violence towards doctors and against any sign of
their stigmatisation by promoting zero tolerance of violence in
healthcare settings.
7. Support the medical profession that continues to honour its
commitment to science and patients. Because current medical
professionalism is one of the few and last defence that the seri-
ously ill,excluded and helpless patients have to maintain a mini-
mum of health, quality of life and human dignity.
8. Urge governments to include health system strengthening and
resilience as part of national COVID recovery plans.
WMA Statement Concerning
the Relationship Between
Physicians and Commercial
Enterprises
Adopted by the 55th
WMA General Assembly, Tokyo, Japan, October
2004, amended by the 60th
WMA General Assembly, New Delhi, India,
October 2009; And by the 71st
WMA General Assembly (online), Cor-
doba, Spain, October 2020
Preamble
In the treatment of their patients, physicians use medicines, instru-
ments, diagnostic tools, equipment and materials developed and
BACK TO CONTENTS
32
General Assembly Report
produced by commercial enterprises.Industry possesses resources to
finance expensive research and development programmes,for which
the knowledge and experience of physicians are essential. Moreover,
industry support enables the progress of medical research, scientific
conferences and continuing medical education that can be of benefit
to patients and the entire health care system. The combination of
financial resources and product knowledge contributed by industry
and the medical knowledge possessed by physicians enables the de-
velopment of new diagnostic procedures,drugs,therapies,and treat-
ments and can lead to great advances in medicine.
However, conflicts of interest between commercial enterprises and
physicians occur and can affect the care of patients as well as the
reputation of the medical profession. The duty of the physician is
to objectively evaluate what is best for the patient and to promote
the patient-physician relationship, while commercial enterprises are
expected to bring profit to owners by selling their own products and
competing for customers. Commercial considerations can affect the
physician’s objectivity, especially if the physician is in any way de-
pendent on the enterprise.
Rather than forbidding any relationships between physicians and
industry, it is preferable to establish guidelines for such relation-
ships. These guidelines must incorporate the key principles of dis-
closure, transparency, avoidance of conflicts of interest and promot-
ing the physician’s ability to act in the best interests of patients.
The guidelines regulating the Physician-Commercial Enterprise re-
lationship should be understood in the light of WMA core ethical
values, as stated in particular in the Declaration of Geneva, the Inter-
national Code of Medical Ethics. the Statement on Conflict of Interest,
and the Declaration of Seoul on Professional Autonomy and Clinical
Independence.
The autonomy and clinical independence of physicians should be
foremost in all physician decisions for patients,regardless of practice
setting,whether government-sponsored,private,for profit or not for
profit, investor funded, insurance company employers or otherwise.
Curricula of medical schools and residency programs should in-
clude educational courses on the relation between enterprises and
the medical profession in the light of ethical principles and values
of the profession.
Recommendations
Medical conferences
1. These guidelines related to medical conferences apply, where
pertinent, to corporation events, such as educational events,
and promotional activities including for items of medical utility,
sponsored by a commercial enterprise.
2. Physicians may attend medical conferences, sponsored in whole
or in part by a commercial entity if these conform to the follow-
ing principles:
–
– The main purpose of the conference is the exchange of pro-
fessional or scientific information for the benefit of patient
care.
–
– Hospitality during the conference is secondary to the profes-
sional exchange of information and does not exceed what is
locally customary and generally acceptable.
–
– Physicians do not receive payment directly from a commer-
cial entity to cover travelling expenses, room and board at the
conference for themselves or an accompanying person or com-
pensation for their time unless provided for by law and/or the
policy of their National Medical Association, or unless it is a
reasonable honorarium for speaking at the conference.
–
– The name of a commercial entity providing financial support
is publicly disclosed in order to allow the medical community
and the public to fairly evaluate the information presented. In
addition, conference organizers and lecturers are transparent
and disclose any financial affiliations that could potentially in-
fluence educational activities or any other substantial outcome
that may result from the conference.
–
– In accordance with the WMA Guidelines on Promotional
Mass Media Appearances by Physicians, presentation of mate-
rial by a physician should be scientifically accurate, give a bal-
anced review of possible treatment options, and not be influ-
enced by the sponsoring organization.
3. In addition, a conference can be recognized for purposes of
continuing medical education/continuing professional devel-
opment (CME/CPD) only if it conforms to the following
principles:
–
– The commercial entities acting as sponsors, such as pharma-
ceutical companies or enterprises in the medical devices sector,
have no influence on the content,presentation,choice of lectur-
ers, or publication of results.
–
– Funding for the conference is accepted only as a contribution to
the general costs of the meeting.
–
– The independence of the contents of the conference is guar-
anteed.
Gifts
4. To preserve the trust between patients and physicians, physi-
cians should decline:
–
– cash, cash equivalents and other gifts for personal benefit from
a commercial entity
–
– gifts designed to influence clinical practice, including direct
prescription incentives.
5. Physicians may accept:
BACK TO CONTENTS
33
General Assembly Report
–
– Promotional aids provided that the gift is of minimal value and
is not connected to any stipulation that the physician uses cer-
tain instruments, medications or materials or refers patients to
a certain facility.
–
– Cultural courtesy gifts on an infrequent basis according to local
standards if the gift is of minimal value and not related to the
practice of medicine.
Research
6. A physician may carry out research funded by a commercial
entity, whether individually or in an institutional setting, if it
conforms to the following principles:
–
– The physician is subject only to the law, the ethical principles
and guidelines of the Declaration of Helsinki, and clinical
judgment when undertaking research and should guard against
external pressure regarding the research results or its publica-
tions.
–
– If possible, a physician or institution wishing to undertake
research approaches more than one commercial source for re-
search funds.
–
– Identifiable personal information about research patients or
voluntary participants is not passed to the sponsoring company
without the consent of the individuals concerned.
–
– A physician’s compensation for research is based on his or her
time and effort and such compensation must not be connected
to the results of the research.
–
– The results of research are made public with the name of the
sponsoring entity disclosed, along with a statement disclosing
who requested the research. This applies whether the sponsor-
ship is direct or indirect, full or partial.
–
– Commercial entities allow unrestricted publication of research
results.
–
– Where possible, research financed by commercial enterprises
should be managed by interposed, non-profit entities, such as
institutes or foundations.
Affiliations with Commercial Entities
7. A physician may not enter into an affiliation with a commercial
entity, such as consulting or membership on an advisory board
unless the affiliation conforms to the following principles:
–
– The affiliation does not compromise the physician’s integrity.
–
– The affiliation does not conflict with the physician’s obligations
to his or her patients.
–
– The affiliation or other relationship with a commercial entity is
fully disclosed in all relevant situations,such as lectures,person-
al appearances, articles, reports and influential contributions to
the mission of medical associations or other non-profit health
entities.
WMA Statement on Human
Genome Editing
Adopted by the 71st
WMA General Assembly (online), Cordoba, Spain,
October 2020
Preamble
Genome editing, enabled by recent scientific advances, can gener-
ate targeted insertions and deletions in DNA and may even offer
enough precision to modify a single base pair within the genome
of an organism. Basic science research with genome editing is now
underway in laboratories globally.
Human genome editing is also advancing rapidly, with clinical tri-
als now in progress for prevention and treatment of various human
diseases.These trials, which are currently in early stages, involve so-
matic (non-reproductive) cells, and thus are not anticipated to in-
troduce genetic changes that will be passed on to offspring or the
germline (reproductive) cells.
While genome editing holds great potential to help improve human
lives, the technology raises profound safety, ethical, legal, and social
concerns.These concerns are compounded by the fact that regulato-
ry and ethical guidance often lag rapid technological developments.
Safety concerns for genome editing include the risk of unintend-
ed or unforeseen pleiotropic effects off-target effects (edits in the
wrong place) unwanted on-target modifications (imprecise edits),
and mosaicism (when only some cells carry the edit), and abnormal
immunological responses.
Ethical issues regarding genome editing include concerns that edit-
ing may be used for non-therapeutic and enhancement purposes
rather than for therapeutic purposes, i.e. improving health or curing
disease. There are also concerns that germline modifications could
create classes of individuals defined by the quality of their engi-
neered genome, possibly enabling eugenics, which could exacerbate
social inequalities or be used coercively.
The effect of epigenomic changes are unpredictable, and there is
disquiet as to how this will affect the existing healthy biological sys-
tems,including interactions with other genetic variants,and societal
norms. Once introduced into the human population, genetic altera-
tions would be difficult to remove and would not remain within any
single community or country.The effects could remain uncertain for
many subsequent generations, during which time deleterious modi-
fications could be dispersed throughout the population.
BACK TO CONTENTS
34
General Assembly Report
Legal issues include providing clarity for risk management and as-
signment of duties and liabilities, particularly when modifications
can be passed to subsequent generations. There are also risks, both
legal and ethical, involved in the proliferation of unvalidated direct-
to-consumer CRISPR (clustered regularly interspaced short palin-
dromic repeats) kits that allow individuals to undertake gene editing
independently in a home setting.
At a social level, debates revolve around the concerns that access to
beneficial genome editing will be inequitable (e.g., only the wealthy
will have access) and will increase existing disparities in health and
medical care.
The WMA reaffirms principles in the Declaration of Reykjavik on
the ethical considerations regarding the use of genetics in health care, the
Declaration of Taipei on Ethical Considerations regarding Health
Databases and Biobanks and the Declaration of Helsinki and makes
the following recommendations:
Recommendations
1. Human genome-editing, like any other medical intervention,
should be implemented according to appropriate evidence that is
collected via well-conducted and ethically approved research studies.
2. When contemplating use of germline cells for research purpos-
es, germline editing should be permitted only within a separate
ethical and legal framework, distinct from an ethical and legal
framework applied to somatic genome editing.
3. Governments should:
–
– Develop robust and enforceable regulatory frameworks for ge-
nome editing in their own countries.
–
– Urge continued development of an international consensus,
grounded in science and ethics, to determine permissible thera-
peutic applications of germline genome editing.
4. WMA constituent members should:
–
– Be cognisant of the advances in research in genomic medicine
and inform their members on scientific advances in genome
–
– Advocate for research to understand (i) the benefits and risks
of human genome editing, (ii) the socio-political, ethical, and
legal aspects of editing the human germline and (iii) the neces-
sity of physician involvement in therapeutic genome editing.
–
– Develop and promote ethical guidelines for genome editing for
their members, taking into consideration societal perspectives,
professional consensus, national laws and regulations, and in-
ternational standards.
–
– Advocate for the development of appropriate laws and regula-
tions for genome editing in accordance with both international
and national norms and standards.
–
– Where human genome editing is safe and effective, advocate
for equal patient access to the technology.
5. Physicians should:
–
– Educate themselves on the technical, ethical, social, and legal
aspects of genome editing.
–
– Familiarise themselves with the international and local ethical
frameworks regulating genome
–
– Follow all ethical standards for approved research in these areas,
including appropriate informed consent.
WMA Statement on Hyperten-
sion and Cardiovascular Disease
Adopted by the 71st
WMA General Assembly (online), Cordoba, Spain,
October 2020
Preamble
Hypertension is the single most important risk factor for cardiovas-
cular death globally. It accounts for more deaths from cardiovascu-
lar disease than any other modifiable risk factor. More than half of
people who die from coronary heart disease and stroke had hyper-
tension. “As populations age, adopt more sedentary lifestyles, and
increase their body weight, the prevalence of hypertension world-
wide will continue to rise.
Uncontrolled hypertension is a major cause of stroke and other co-
morbid, chronic conditions, such as heart failure, kidney disease, vi-
sion loss, or mild cognitive impairment. Because hypertension can
be asymptomatic, it may often go undiagnosed.
In 2010, hypertension emerged as the leading risk factor for dis-
ease burden in every region of the world. Moreover, elevated sys-
tolic blood pressure (SBP) is a leading global health risk.The WHO
Global Plan of Action for the prevention of non-communicable
diseases calls for a 25% reduction in the prevalence of elevated blood
pressure by 2025.
Prevalence
Worldwide prevalence of hypertension has grown significantly over
the past four decades, and most with hypertension are not achieving
optimal control.
Of concern is an increasing disparity in hypertension prevalence be-
tween high-income and low/middle–income countries.Almost three
BACK TO CONTENTS
35
General Assembly Report
times as many people with hypertension live in low/middle–income
countries than in high-income countries. Low-income countries in
south Asia, sub-Saharan Africa, and central and eastern Europe, are
particularly impacted. Moreover, the prevalence of elevated blood
pressure was highest in certain regions of Africa in both sexes.
Risk Factors
Hypertension risk factors are attributes that increase the likelihood
of developing the disease. Risk factors include the following:
• Lifestyle/Diet: Unavailability of healthy food choices, lack of
access to safe neighborhoods for exercising, and unhealthy life-
style habits can raise the risk of hypertension. Unhealthy lifestyle
habits include unhealthy eating patterns such as eating too much
sodium and highly processed food, drinking too much alcohol,
smoking, and being physically inactive.
• Age: Blood pressure (BP) tends to increase with age. However,
the risk of hypertension is increasing for children and teens, pos-
sibly due to the rise in the number of children and teens who are
overweight or obese.
• Socioeconomic Status: In high-income countries,the greatest ab-
solute burden of hypertension disease is in age groups 60 years
and older, whereas in low/middle-income countries, the great-
est absolute burden is in the middle-aged groups, such as 40
to 59 years. The age-standardized prevalence of hypertension is
higher in low/middle-income countries than in high-income
countries.
• Sex: Before age 55, men are more likely than women to develop
hypertension. After age 55, women are more likely than men to
develop it.
• Genetics/Family History: Research has identified many gene
variations associated with small increases in the risk of developing
hypertension. Some people are genetically predisposed to dietary
sodium sensitivity.
Accurate blood pressure measurement
The accurate measurement of BP – both within the clinical setting
and at home – is essential for the diagnosis and management of
hypertension.In many countries,national clinical guidelines recom-
mend how to achieve an accurate BP measurement and offer best
practice recommendations.
Policy implications
Policies and actions at the global, national, and local levels are
necessary to recognize and combat hypertension. Much effort is
needed worldwide to improve awareness, treatment, and control
for all populations. Current guidelines to diagnose and treat hy-
pertension, and evidence-based guidance on the importance of
proper BP measurement, offer anchors for national policies on BP
measurement and control. Implementation can make significant
progress towards lowering global hypertension prevalence and im-
proving patient outcomes. To address the risk factors for hyper-
tension, policies should also focus on addressing socioeconomic,
lifestyle and dietary factors which contribute to the development
of the disease.
Recommendations
1. The World Medical Association recommends that national gov-
ernments:
–
– Recognize hypertension as the single most important risk fac-
tor for cardiovascular disease and death.
–
– Declare hypertension control a national health priority.
–
– Support campaigns to raise public awareness of hypertension,
including recognition of its widespread and asymptomatic na-
ture, and its risk of contributing to development of other seri-
ous diseases.
–
– Deploy adequate resources to improve hypertension awareness,
diagnosis, measurement, and management.
–
– Develop country-specific strategies which address the risk fac-
tors for hypertension and advocate for improvements in aware-
ness, diagnosis, measurement and management.
–
– Promote the recommendations adopted by the WMA as stated
in the Statement on Reducing Dietary Sodium Intake.
2. The World Medical Association recommends that its constitu-
ent members:
–
– Advocate at the international, national, and local levels to
promote hypertension awareness, healthy lifestyles, and pa-
tient access to hypertension diagnosis and treatment includ-
ing medications. This includes supporting the concept that
social determinants of health are part of hypertension disease
prevention.
–
– Recognize and support national guidelines and strategies for
measuring BP accurately.
–
– Support the exchange of hypertension research, information,
tools, and other resources amongst healthcare teams and pa-
tients.
–
– Support the development of medical curricula that respond to
societal hypertension needs with a focus on community-based
primary care training and BP measurement and management
skills.
–
– Promote research on the causes, mechanisms and effective
treatments of hypertension.
–
– Advocate for sustained availability antihypertensive medica-
tions.
BACK TO CONTENTS
36
General Assembly Report
3. The World Medical Association recommends that physicians:
–
– Emphasize the risk factors for hypertension and ways to miti-
gate them,paying special attention to prevention and treatment
in high-risk populations.
–
– Emphasize team-based care to help prevent and, where it has
been diagnosed by a physician, to treat hypertension.
–
– Implement BP measurement best practices and techniques,
including training and retraining of all healthcare team mem-
bers.
–
– Promote patient hypertension treatment adherence by facilitat-
ing ongoing patient BP self-management and involvement in
the patient’s own care.
WMA Statement on Measures
for the Prevention and Fight
Against Transplant-Related
Crimes
Adopted by the 71st
WMA General Assembly (online), Cordoba, Spain,
October 2020
Preamble
In 2017, almost 140,000 solid organ transplants were performed
worldwide. Although impressive, this activity provided for only
10% of the global need for transplanted organs. The disparity
between supply and demand of organs has led to the emergence
of transplant-related crimes, including trafficking in persons for
the purpose of the removal of organs and trafficking in human
organs.
These crimes violate fundamental human rights and pose seri-
ous risks to both individual and public health. The true extent of
transplant-related crimes remains unknown, but it is estimated that
5% to 10% of transplants globally take place in the context of the
international organ trade,often involving transplant tourism to des-
tinations where laws against the sale and purchase of human organs
are nonexistent or poorly enforced. Trafficking in persons for the
purpose of the removal of organs and trafficking in human organs
can also take place within the boundaries of a given jurisdiction, not
involving travel for transplantation. In all cases, the most vulnerable
parts of the population often become victims of exploitation and
coercion.
Concerned by the increasing demand for organs and by emerging
unethical practices in the field, the World Health Organization has
called on governments and health professionals to pursue self-suffi-
ciency in transplantation, through strategies targeted at decreasing
the burden of diseases treatable with transplantation and increasing
the availability of organs, maximising donation from the deceased
and ensuring the overall protection of the living donor. Progress to-
wards self-sufficiency in transplantation is consistent with the es-
tablishment of official cooperation agreements between countries to
share organs or to facilitate patients’ access to transplant programs
that have not been developed in their countries of origin. Agree-
ments between countries should be based on the principles of jus-
tice, solidarity and reciprocity.
Progress towards self-sufficiency in transplantation is the best long-
term strategy to prevent transplant-related crimes.
The distinctive feature of transplant-related crimes is the necessary
involvement of health professionals. It is precisely this feature that
provides a unique opportunity to prevent and combat these crimes.
Health professionals are key in evaluating prospective living donor
and recipient pairs. They also care for desperate patients who are
vulnerable and at risk of engaging in illicit transplant activities. In
addition, since patients who receive a transplant require long-term
specialised care, physicians must deal with the many challenges of
providing care to patients who have received an organ through illicit
means, while unveiling trafficking rings.
International organisations, including the Council of Europe, the
European Union and the United Nations, as well as international
professional platforms, have developed treaties, resolutions and
recommendations for a concerted fight against transplant-related
crimes.
The WMA emphasises the responsibility of physicians in prevent-
ing and combatting trafficking in persons for the purpose of the
removal of organs and trafficking in human organs, as well as the
important role of physicians and other health-care professionals in
assisting international organisations, medical associations and poli-
cy makers in the fight against these criminal activities.
In the fight against transplant-related crimes it is of utmost impor-
tance that the principles of transparency of practice, traceability of
organs and continuity of care are guaranteed for every transplant
procedure performed nationally or abroad.
The WMA reaffirms its Statement on organ and tissue donation and
its Declaration of Sydney on the determination of death and the recovery
of organs. Condemning all forms of trafficking in persons for the
purpose of the removal of organs and trafficking in human organs,
BACK TO CONTENTS
37
General Assembly Report
the WMA calls for the implementation of the following recom-
mendations.
Recommendations
Policy makers and health actors:
1. Governments should develop, implement and vigorously en-
force legislative frameworks that prohibit and criminalise traf-
ficking in persons for the purpose of the removal of organs and
trafficking in human organs, these should include provisions to
prevent these crimes and protect their victims.
2. Governments should consider ratifying or acceding to the Unit-
ed Nations Convention against Transnational Organised Crime
and the Protocol to Prevent, Suppress and Punish Trafficking in
Persons, Especially Women and Children, supplementing the
United Nations Convention against Transnational Organised
Crime, as well as the Council of Europe Convention against
Trafficking in Human Organs. They should also consider co-
operating with existing international organisations for a more
effective fight against transplant-related crimes. The WMA
should play a leading role in influencing ethical practices in do-
nation and transplantation.
3. Health authorities should develop and maintain registries to
record information regarding each organ recovery and trans-
plantation procedure, as well as information on the outcomes
of living donors and organ recipients, to ensure the traceability
of organs, with due regard to professional confidentiality and
personal data protection. Registries should be designed to re-
cord information on procedures that take place within a country
and on transplant and living donation procedures on residents
of that country carried out in other destinations.
4. Countries are encouraged to periodically contribute this in-
formation to the Global Observatory on Donation and Trans-
plantation developed in collaboration with the World Health
Organization.
5. Health authorities and medical associations should ensure that
all health professionals are trained in the nature,extent and con-
sequences of transplant-related crimes, as well as in their re-
sponsibilities and duties in preventing and fighting these crimi-
nal activities and in the means to do so.
6. As self-sufficiency is the best long-term strategy to prevent
transplant-related crimes, health authorities and policy makers
should develop preventive strategies to decrease the burden of
diseases treatable with transplantation and increase the avail-
ability of organs.
7. Increasing organ availability should be based on the develop-
ment and optimisation of ethically sound deceased donation
programs following the determination of death by neurologi-
cal and by circulatory criteria. Of note is that donation after
the determination of death by circulatory criteria is accepted
in a limited number of countries. Governments should explore
whether donation after the circulatory determination of death is
a practice acceptable within their community and,should this be
the case, consider introducing it within their jurisdiction.
8. In addition, governments should develop and optimise living
donation programs based on recognised ethical and professional
standards and ensure due protection and follow-up of living do-
nors.
9. Health authorities and/or insurance providers should not reim-
burse the costs of transplant procedures that have occurred in
the context of transplant-related crimes. However, the costs of
medications and post-transplant care should be covered, as for
any other transplant patient.
10. Authorities should also ensure that medical and psychosocial
care is provided to victims of trafficking in persons for the pur-
pose of organ removal and of trafficking in human organs. Con-
sideration should be given to effective compensation of these
persons for the damage suffered.
11. National Medical Associations should advocate for and cooper-
ate with authorities in developing frameworks for health profes-
sionals to report any confirmed or suspected case of trafficking
of persons for the purpose of the removal of organs and of traf-
ficking in human organs to the relevant authorities. National
Medical Associations should advocate for the ability of health
professionals to report suspected trafficking of individual per-
sons, on an anonymous basis if necessary, to protect the safety of
the reporter.Where applicable, the reporting of trafficking cases
should be a permitted exception to the physician’s obligation to
maintain patient confidentiality
Physicians and other health professionals:
12. Physicians should never perform a transplant using an organ
that has been illicitly obtained. If there are reasonable concerns
about the origin of an organ, the organ must not be used. If a
physician or a surgeon is asked to perform a transplant with an
organ that has been obtained through a financial transaction,
without the valid consent of the donor or without the authori-
sation required in a given jurisdiction, they must refrain from
performing the transplant and should explain the reasons to the
potential recipient.
13. Physicians who participate in the preoperative evaluation of po-
tential living donors should not only assess the medical suitabil-
ity of the individual, but also attempt to ensure that the person
has not been subject to coercion of any kind or is participating in
the procedure for financial gain or any other comparable advan-
tage.The legitimacy of the donor-recipient relationship and the
altruistic motivations for donation should be scrutinised. Phy-
sicians should be particularly vigilant of “red flags” suggestive
of a transplant-related crime. Non-resident living donors may
BACK TO CONTENTS
38
General Assembly Report
be particularly vulnerable and should be given special consider-
ation. For linguistic, cultural and other reasons, assessing the va-
lidity of their consent to donation can be especially challenging,
as can ensuring that appropriate follow-up is offered to them. A
referring physician should be identified in the country of origin
of the living donor – and in that of their intended recipient,
where appropriate.
14. Physicians should never promote or facilitate the engagement
of patients in transplant-related crimes. Moreover, they should
inform patients of the risks these activities pose for their own
health, that of their loved ones and, more generally, for pub-
lic health. Patients should also understand that these activities
entail an exploitation of vulnerable individuals who may them-
selves suffer from severe medical and psychosocial complica-
tions. By counselling patients, professionals may dissuade them
from engaging in illicit transplant activities.
15. Physicians have a duty to care for transplant patients, even if
their organ was illicitly Should a physician have ethical or moral
objections about caring for a patient who has received an illicit
organ, they should make the necessary arrangements to transfer
the care of the patient to another physician.
16. Physicians should contribute to guaranteeing transparency of
practices and traceability of organs. When patients who have
undergone a donation or a transplantation procedure abroad
seek follow-up care in their country of residence, all relevant
information should be recorded in national transplant-registries
and reported to health authorities, as should happen for all do-
nation and transplantation procedures performed within the
national transplant system.
17. Physicians have a responsibility to increase the deceased donor
pool in order to satisfy the transplantation needs of patients.
Physicians also have a duty towards possible organ donors in
considering and facilitating organ donation if this is consistent
with patients’ values and principles. Donation should be rou-
tinely offered as an option at the end of life, always in a respect-
ful manner, taking into account the culture and religion of the
potential donor and their surrogates. Conversations about do-
nation opportunities should be led by experienced and trained
professionals.
18. Physicians should promote research in the field of donation
and transplantation, in particular research targeted at increas-
ing the availability of organs for transplantation, improving
the outcomes of transplanted organs, and identifying alterna-
tive organ replacement strategies, as in the case of bioartificial
organs.
WMA Statement on Stem Cell
Research
Adopted by the 60th
WMA General Assembly, New Delhi, India, October
2009 and revised by the 71st
WMA General Assembly (online), Cordoba,
Spain, October 2020
Preamble
The fields of stem cell research and therapy are among the fastest
growing areas of biotechnology.
Stem cells can be harvested from established tissue (adult stem
cells) or from the blood of the placenta via the umbilical cord.These
sources may create no specific ethical dilemmas.
Stem cells can also be obtained from an embryo (embryonic stem
cells). Obtaining and using these stem cells raises specific ethical
questions and may be problematic for some people. Another source
of stem cells valuable for research is induced pluripotent stem cells,
which can be generated from adult tissues,and may in some cases be
functionally equivalent to embryonic stem cells, although they are
not derived from embryos.
Some jurisdictions have prohibited using embryonic stem cells.
Others have allowed using so-called “spare or excess embryos”from
assisted reproduction procedures for research purposes, but the pro-
duction of embryos solely for research purposes may be prohibited.
Other jurisdictions have no specific laws or regulations with respect
to embryonic stem cells.
Human embryos are considered by some people to have a specific
and special ethical status. This has generated debate amongst ethi-
cists, philosophers, theologians, clinicians, scientists, health workers,
the public and legislators.
In vitro fertilisation involves the production of embryos outside of
the human body.In many cases,some of the embryos are not used to
achieve pregnancies. Those not used may be donated for the treat-
ment of others, or for research, or stored for some time and then
destroyed.
Stem cells can be used to conduct research into basic developmen-
tal biology, human physiology and disease pathogenesis. There are
many current research programs investigating the use of stem cells
to treat human disease. Adult stem cell therapies, including using
bone marrow, cord blood or blood-derived stem cells for transplan-
BACK TO CONTENTS
39
General Assembly Report
tation, include several important and well-validated clinical ad-
vances. In contrast, clinical studies have not yet validated the use of
embryonic stem cells in therapy.
Embryonic stem cells may at times be superior to induced plu-
ripotent stem cells for certain applications, and research with
embryonic stem cells may continue to be needed. Some experts
anticipate future use of a variety of therapies based on stem cells,
including transplants of genetically matched tissue. It is too early
to assess the likelihood of success of any specific therapy based on
stem cells.
Public views of stem cell research are as varied as those of doctors
and scientists. Much public debate centers on concerns of abuse of
the technology and the potential for harm in recipients, and specific
concerns continue to be raised about the use of embryos. Investi-
gational stem cell products also may pose unique risks, including
unknown long-term health effects such as mutations.
Adoption of laws in accordance with established ethical princi-
ples* is likely to alleviate concerns for many members of the pub-
lic, especially if such laws are carefully and credibly monitored and
enforced.
Recommendations
1. Whenever possible, research should be carried out using stem
cells that are not of embryonic origin. Research with stem cells
from unused embryos after in vitro fertilization techniques
should only be carried out if obtaining the potential results
could not also be addressed with the use of other types of stem
cells, including induced pluripotent stem cells. Research and
other uses should be in accordance with the WMA Resolu-
tion on the Non-Commercialisation of Human Reproductive
Material.
2. All research on stem cells, regardless of stem cell type, must be
carried out according to established ethical principles and with
appropriate informed consent. Both established and proposed
laws must conform to these principles to avoid confusion or
conflicts between law and ethics.
3. The ethical principles should, where possible, follow inter-
national agreements. Recognising that different groups have
widely varying views on the use of specific stem cell types,
these principles should be drafted with enough flexibility to
allow different jurisdictions to appropriately regulate levels of
research.
WMA Statement on Violence
Against Women
Adopted by the 61st
WMA General Assembly, Vancouver, Canada, Oc-
tober 2010 And amended by the 71st
WMA General Assembly (online),
Cordoba, Spain, October 2020
Preamble
Violence against women is a worldwide phenomenon and includes
violence within the family, within the community and violence per-
petrated by or condoned by the state. Many excuses are given for vi-
olence generally and specifically; in cultural and societal terms,these
include tradition, beliefs, customs, values and religion. Intimate
partner violence, rape, sexual abuse and harassment, intimidation at
work or in education, modern slavery, trafficking and forced pros-
titution, are all forms of violence condoned by some societies. One
extreme form of such violence is sexual violence used as a weapon
of war (United Nations Security Council Resolution 1820). Spe-
cific cultural practices that harm women, including female genital
mutilation, forced marriages, dowry attacks and so-called “honour”
killings are all practices that may occur within the family setting.
All human beings enjoy fundamental human rights. The examples
listed above involve denial of many of those rights, and each abuse
can be examined against the Universal Declaration of Human Rights,
as well as the Convention on the Elimination of All Forms of Dis-
crimination against Women and the Protocol to Prevent, Suppress and
Punish Trafficking in Persons Especially Women and Children, supple-
menting the United Nations Convention against Transnational Or-
ganized Crime (2000).
The denial of rights and the violence itself have health consequences
to women. In addition to the specific and direct physical and health
consequences, the general way in which women are treated can
lead to an excess of mental health problems and increase of suicidal
behavior. The short and long-term mental health consequences of
violence may severely influence later wellbeing, enjoyment of life,
function in society and the ability to provide appropriate care for
dependents.Lack of good nutritional opportunities can lead to gen-
erations of women with poorer health, poorer growth and develop-
ment. Denial of educational opportunities leads to poorer health for
all the family members since good education of women is a major
factor in the wellbeing of the family.
In addition to being unacceptable in and of itself, violence against
women is also socially and economically damaging to the family and
BACK TO CONTENTS
40
General Assembly Report
to society. There are direct and indirect economic consequences to
violence against women that are far greater than the direct health
sector costs. Lack of economic independence, and of basic educa-
tion, also mean that women who survive abuse are more likely to be
or to become dependent upon the state or society and less able to
support themselves and contribute to that society.
Physicians have a unique insight into the combined effects of vio-
lence against women.The holistic view from physicians can be used
to influence society and politicians.Gaining societal support for im-
proving the rights, freedom and status of women is essential.
This Statement alongside with other WMA key related policies, in-
cluding the statements on Female Genital Mutilation, Sex Selection
and Female Foeticide, Medically-indicated Termination of Pregnancy,
Family Violence, Violence and Health, Child Abuse and Neglect and on
the Right of Rehabilitation of Victims of Torture, provide guidance to
WMA Constituent Members and physicians on ways to support
women who are victims of violence, and strive for eradicating vio-
lence against women.
Recommendations
The WMA:
1. Calls for zero tolerance for all forms of violence against women.
2. Asserts that violence against women is not only about physi-
cal, psychological and sexual violence but includes neglect and
abuses such as harmful cultural and traditional practices and is
a major public health issue as well as a social determinant of
health.
3. Recognizes the linkage between better education,other women’s
rights and societal health and wellbeing, and emphasizes that
equality in civil liberties and human rights are health-related
issue.
4. Calls on WHO, other United Nations agencies and relevant
actors at national and international levels to accelerate actions
towards ending discrimination and violence against women.
5. Urges the governments to implement WHO’s Global Plan of Ac-
tion to Strengthen the Role of the Health System within a National
Multisectoral Response to Address Interpersonal Violence, in particu-
lar Against Women and Girls, and Against Children.
6. Encourages the development of free educational materials on-
line to provide guidance to front line health care personnel on
abuse and its effects, and on prevention strategies.
National Medical Associations are urged to:
7. Use and promote the available educational materials on prevent-
ing and treating the consequences of violence against women
and act as advocates within their own country.
8. Seek to ensure that physicians and other health care personnel
are alerted on the phenomenon of violence, its consequences,
and the evidence on preventative strategies that work, and place
appropriate emphasis on this in undergraduate, graduate and
continuing education.
9. Recognise the importance of more complete reporting of vio-
lence and encourage the development of education emphasising
violence awareness and prevention.
10. Advocate for legislation against specific harmful practices in-
cluding female feticide, female genital mutilation, forced mar-
riage, and corporal punishment.
11. Advocate for the criminalization of intimate partner violence
as well as rape in all circumstances including within marriage.
12. Advocate for the development of research data on the impact of
violence and neglect upon primary and secondary victims and
upon society, and for increased funding for such research.
13. Encourage medical journals to publish more of the research
on the complex interactions in this area, thus keeping it in the
professions’ awareness and contributing to the development of
a solid research base and ongoing documentation of types and
incidence of violence.
14. Advocate for the national implementation of the Convention on
the Elimination of All Forms of Discrimination against Women
(CEDAW).
Physicians are encouraged to:
15. Use the material developed for their education to better inform
themselves about the effects of violence and the successful strat-
egies for prevention.
16. Treat and reverse, where possible, the complications and adverse
effects of female genital mutilation and refer the patient to social
support services.
17. Oppose the publication or broadcast of victims’ names or ad-
dresses without the explicit permission of the victim.
18. Assess risk of family violence in the context of taking a routine
social history of a patient.
19. Be alert to the association between alcohol or drug dependence
among women and a history of abuse.
20. Where appropriate, report suspected violence or ill-treatment
against women to relevant protection services and take the nec-
essary measures to ensure that victims of violence are not at risk.
21. Support global and local action to better understand the health
consequences both of violence and of the denial of rights, and
advocate for increased services for victims.
BACK TO CONTENTS
41
Declaration of Geneva
Since 1948 the Declaration of Geneva (the
Declaration) has insisted that physicians
must practise medicine “with conscience
and dignity.” In 2017 this provision was
modified by adding, “and in accordance
with good medical practice” [1].
Good medical practice in Canada is said to
include providing euthanasia and assisted
suicide or arranging for someone else to do
so. From this perspective, physicians who
cannot in conscience kill their patients or
collaborate in killing are not acting “in ac-
cordance with good medical practice,”and –
some might say – the revised Declaration.
However, this merely literal application of
the text cannot be correct, since the WMA
later reaffirmed its support for physicians
who refuse to provide or refer for eutha-
nasia and assisted suicide even where they
are considered good medical practice [2].
A reading informed by the history of the
document is necessary and consistent with
the care taken in its revision [1]. This yields
a rational and coherent account of the rela-
tionship of conscience and dignity to medi-
cal practice.
The Declaration of Geneva
and the Ethic of Medicine
The possibility that conscience and dignity
could conflict with good medical practice
did not occur to the authors of the original
Declaration. On the contrary: they believed
conscience and human dignity were inex-
tricably embedded in good medical prac-
tice because they understood the practice
of medicine to be a moral enterprise. They
believed that practising “with conscience”
meant conforming to “eternal moral values”
discernable in the spirit of the Hippocratic
Oath, including respect for “the value and
sanctity of every individual human being”
[3].
Jewish WMA delegates identified “the eter-
nal base of the medical moral [i.e.,ethic]” as
“man thou art my brother”[4].This succinct
statement reflected Judeo-Christian tradi-
tions, but it is consonant with a rational,
cogent and trans-cultural medical ethic
compatible with religious and non-religious
belief. It sums up an “other-self” ethic: the
conviction that physicians’ ethical obliga-
tions flow directly from recognition of the
patient as another self.
Thus,to practise “with conscience”is to treat
the other as oneself: to impartially care for
patients to the best of one’s ability, apply-
ing “scientific methods allied with the spirit
of charity and service”: to provide for their
bodily needs, relieve suffering, prolong hu-
man life and prevent disease: to defend
fundamental human rights and respect pa-
tients’ human dignity and “moral freedom”
[3, 5, 6]. Further, recognition of a patient
as another self-obliges physicians to prevent
and resist harm to patients, and makes de-
liberately harming them an especially egre-
gious offence [4, 5, 7].
The WMA founders denounced physi-
cians involved in crimes against humanity
for having treated human beings as things
to be exploited, and for acting or allowing
themselves to be used as mere technicians
or tools of the state, conduct they character-
ized literally as prostitution [3, 6]. For phy-
sicians in a world staggering back from the
edge of an abyss, to practise medicine “with
dignity” meant that physicians must act
as moral agents, not puppets, and patients
must be respected, protected and cared for,
not used as objects for manipulation, scien-
tific study or personal gratification [8].
The Declaration of Geneva
and the UDHR
This account accords remarkably with the
contemporaneous development of Article
1 of the Universal Declaration of Human
Rights (UDHR), which asserts that all hu-
man beings are endowed with conscience
and equal in dignity. Unsurprisingly, the au-
thors of the UDHR also held that human
dignity forbids the use of human beings as
means to ends chosen by others [9].
Of particular interest, “conscience” was
added to Article 1 because it was thought
to combine the Confucian concept of jen
(pronounced “ren”) with the western idea
of a unique human attribute that grounds
moral obligations [9,  10]. When trans-
lated literally as “two-man-mindedness”  –
­
consciousness of fellow human beings – jen
Sean Murphy Ramona Coelho Philippe D.
Violette
Ewan C Goligher Timothy Lau Sheila Rutledge
Harding
Rene Leiva
The Declaration of Geneva: Conscience, Dignity and Good Medical Practice
CANADA
BACK TO CONTENTS
42
Declaration of Geneva
corresponds to the medical ethic expressed
by the aphorism,“man thou art my brother.”
Indeed, jen   – “Confucius’ version of the
golden rule” – is a foundational principle in
traditional Chinese medical ethics [11, 12].
The symmetry of UDHR Article 1 and the
Declaration and congruence with religious
and non-religious belief in their approach to
conscience and human dignity seem partic-
ularly fitting in documents addressed to the
global community. Here we develop some
key elements relevant to medical practice.
To practise “With
Conscience and Dignity”
We reaffirm the foundational insight of the
authors of the Declaration that the practice
of medicine is an inescapably moral enter-
prise. Physicians first consider the good of
patients [13], always seeking to do them
some kind of good and protect them from
evils [14, 15]. Hence, moral or ethical views
are intrinsic to the practice of medicine, and
every decision concerning treatment is a
moral decision, whether or not physicians
consciously advert to it. To demand that
physicians must not act upon moral beliefs
is to demand the impossible, since one can-
not practise medicine without reference to
moral beliefs.
The practice of medicine is a moral enter-
prise, and the practice of morality is a hu-
man enterprise. None can avoid the classic
ethical question,“How ought I to live?”An-
swers reflect two fundamental moral norms;
do good, avoid evil. These basics have tra-
ditionally been undisputed; disputes begin
with beliefs about good and evil and what
constitutes “doing” and “avoiding.” Such is-
sues are the province of philosophy, ethics,
theology and religion – not science.
Further, since morality is a human enter-
prise,moral judgement is an essential activi-
ty of every human person. Beliefs are always
“personal”in the sense that one is personally
committed to them. Religious and non-re-
ligious people “personally” adhere to beliefs
about human dignity and justice. In neither
case does “personal” commitment imply
that their beliefs are merely idiosyncratic
preferences that can be dismissed.
Maintaining one’s personal moral integ-
rity is the aspiration of all who wish to live
rightly. The physician who makes claims of
conscience is a unique someone with a single
identity, served by a single conscience gov-
erning all conduct in private and professional
life [16]. The moral integrity or moral unity
of the human person was highly prized by
Martin Luther King Jr., who described it as
essential for “a complete life”[17, 18].
Finally, with the authors of the Declaration,
we affirm that moral agency is central to
medical practice.Treating physicians as tools
in the hands of the state, health systems or
other masters – as means to ends rather than
moral agents responsible for their actions –
violates human dignity and is incompatible
with human equality and freedom.
Freedom of Conscience
Agreement on foundational principles does
not eliminate disagreements, since people
hold differing reasonable comprehensive
world views leading to different ethical
theories, like deontology, consequentialism,
principlism and virtue ethics [19]. Recog-
nition of rational moral pluralism [20] en-
ables people to live peacefully and produc-
tively with these differences, and this is best
ensured by robust protection of freedom of
thought, of conscience and of religion, all
recognized in Article 18 of the UDHR.The
focus here, as in the Declaration, is on con-
science.
Reason and Conscience
According to UDHR Article 1, “all human
beings are endowed with reason and con-
science and should act toward one another
in a spirit of brotherhood.”This implies that
reason and conscience are compatible and
should lead to a common understanding of
fundamental moral obligations even among
people having different reasonable compre-
hensive views [9].
Indeed, “reasonable persons will think it
unreasonable,”said John Rawls,“to suppress
comprehensive views that are not unreason-
able,though different from their own”[21] –
including comprehensive views informed by
religious belief. He used the parable of the
Good Samaritan to demonstrate how reli-
giously informed views can be incorporated
into public discourse. It is noteworthy that
Leo Alexander, writing fifty years earlier,
had used the parable to explain the basis
of medical ethics [7]. Crucially, claims of
conscience cannot be dismissed as entirely
disconnected from reason; they are the con-
sequence and expression of rational moral
deliberation about the good.
Conscience in Action
The Declaration’s authors understood that
the exercise of conscience involves doing
what one believes to be right (identified
here as perfective freedom) and refusing
to do what one believes to be wrong (here
preservative freedom). Doing what one be-
lieves to be right we call “perfective”because
individual and collective human flourishing
or perfection can be advanced by the pur-
suit of apparent goods. Refusing to do what
one believes to be wrong we call “preserva-
tive”because individual and collective moral
integrity and other goods are preserved by
refusing to participate in apparent evils.
This distinction is independent of par-
ticular beliefs about right, wrong, human
flourishing or perfection [22]. It enables a
principled approach to defending physi-
cians’ ability to practise “with conscience
and dignity” based upon the nature of the
freedom itself.
CANADA
BACK TO CONTENTS
43
Declaration of Geneva
Perfective Freedom
of Conscience
Since one can always find more good to
be done, the exercise of perfective freedom
of conscience is self-driven, proactive, and
expansive. Moreover, pursuing social goods
often requires resources and the coopera-
tion and assistance of others and can con-
flict with others who are pursuing different
goals. Hence, the exercise of perfective free-
dom of conscience is likely to have a greater
impact on the fundamental freedoms of
others than simply refusing to do what one
believes to be wrong.
International instruments and national con-
stitutions already protect perfective freedom
of conscience as an aspect of freedom of
conscience generally. Physicians motivated
by conscience to care for their patients are
usually supported by societies and govern-
ments. Restrictions or limitations usually
result from lack of resources or other prac-
tical impediments that can often be miti-
gated or overcome in time.
One must not minimize the distress felt by
physicians struggling against difficult odds
to do the good they want to do for their
patients [23]. Physicians express frustration
and alarm when government policies keep
them from providing medical services to
vulnerable populations [24]. They are out-
raged when warring factions attack medical
personnel and make it almost impossible to
treat people desperately in need [25].
But it is crucial to recognize that physicians
in these situations are not responsible or
culpable for injustices they have been un-
able to prevent or correct.They may experi-
ence disappointment, frustration, a sense of
failure and even anger, but moral culpability
lies on other shoulders.Their moral integrity
is unaffected.The solution to such problems
is to provide adequate resources, change
government policies, and halt attacks on
medical personnel in war zones. Additional
protection for perfective freedom will not
help to address these problems. Indeed, it
can introduce other difficulties.
For example, managing the scope of even
specific policy positions grounded on per-
fective freedom of conscience is especially
challenging. In 2014 the Canadian Medi-
cal Association (CMA) resolved to support
all physicians who “follow their conscience
in deciding whether to provide medical
aid in dying” [26]: both those who provide
and refuse to provide the services (exercis-
ing perfective and preservative freedom of
conscience respectively). This commits the
CMA to support EAS for any reason for
any person and under any circumstances as
long as it is legal. The commitment is not
conditional upon competence, consent, age
or even medical diagnosis.
Further, physicians are capable of caus-
ing grievous and widespread harm espe-
cially when pursuing ostensibly therapeutic
goals.This was demonstrated at a Canadian
psychiatric institution, where, for 15 years,
physicians openly employed “patient on
patient therapy” [27] designed to under-
mine patients’ personal dignity and sense
of self-worth, described by a court as an
“invasive and brutal” experimental meth-
odology [28]. It would be imprudent and
even dangerous to increase this risk. And
it is unnecessary, because there is no need
to augment protection for perfective free-
dom of conscience to enable or encourage
the provision of medical treatment, which
ought to be justifiable on empirical and
ethical grounds alone.
Preservative Freedom
of Conscience
The justification for protecting freedom of
conscience is the need to preserve personal
integrity and human dignity. Applied to
physicians, this protects patients by ensur-
ing that others cannot force physicians to
act unethically [29]. Augmenting protec-
tion for perfective freedom of conscience is
not required to achieve this end, but there
are a number of reasons to enact protec-
tions specific to preservative freedom of
conscience.
Preservative freedom of conscience is re-
active, typically exercised only in response
to external pressures. Beyond alternative
arrangements customary for accommodat-
ing conflicting rights claims, preservative
freedom of conscience makes no special
demands on social resources, does not re-
quire others to assist or cooperate and is
less likely than perfective freedom of con-
science to infringe others’ fundamental
freedoms.
Refusing to act wrongfully is foundational
for the individual and society, contributes
substantially to social stability and is the
necessary but not sufficient condition for
perfective freedom of conscience. It is es-
sential for ethical medical practice because
it protects personal and professional integ-
rity and can be the ultimate safeguard for
patients.
Moreover, coerced participation in per-
ceived wrongdoing does not merely restrict
preservative freedom of conscience but
suppresses it entirely by forcing a physician
to assume moral responsibility and culpa-
bility for what follows. In contrast, physi-
cians prevented from providing treatment
are relieved of moral responsibility and
culpability.
General guarantees of freedom of con-
science in international instruments and
national constitutions apply to preservative
freedom of conscience, but, unlike perfec-
tive freedom of conscience, they are fre-
quently ignored or interpreted so as to sup-
press it [30, 31]. Preservative freedom of
conscience among health care professionals
has been attacked around the world with
increasing intensity for at least 20 years [32,
33, 34, 35]. In some parts of Canada, the
medico-legal establishment now demands
that unwilling physicians become parties
CANADA
BACK TO CONTENTS
44
to killing their patients; [36] pressures to
conform to this ­
expectation are consider-
able [37] and sometimes vicious [38].
Suppression of preservative freedom of
conscience directly attacks personal in-
tegrity because one cannot act unless one
chooses to act. By yielding to coercion one
consciously commits oneself to a perceived
evil (killing one’s patient) as better than the
consequences of refusal (losing one’s job),
contrary to one’s actual beliefs. By virtue of
the moral unity of the person, one cannot
separate oneself from one’s choices and acts
even if they have been coerced. One knows
forever after that one could have acted dif-
ferently, and this awareness is manifested in
profound guilt [39].
For example, a palliative care physician,
succumbing to fear of professional disci-
pline, referred a patient for euthanasia. She
described the experience as “destructive to
my very core.” Haunted for months by the
memory, she doubted she could continue in
palliative care [40].
There is a further point. When the state
forces physicians to do what they believe
to be wrong it demands the submission of
intellect, will, and conscience to serve ends
they find morally abhorrent. They are treat-
ed as cogs in the state machine, or, to use
the words of Martin Luther King Jr., they
are “thingified” [41]. Immanuel Kant’s in-
sistence that a human person must never be
treated as a means to an end [42] – what we
call the principle against servitude – forbids
the imposition or acceptance of this kind of
treatment, which is fundamentally incom-
patible with human dignity, freedom and
equality and contributes to deeply felt and
lasting shame.
Rational Distinctions,
Limits and Priorities
The distinction between perfective and pre-
servative freedom of conscience is rationally
derived from the exercise of conscience,
without reference to particular ethical sys-
tems or morally contested procedures, while
the principle against servitude recognized
by the authors of the Declaration and the
UDHR is widely accepted [12, 43, 44, 45,
46, 47, 48]. Granted that we cannot address
all issues related to conscience, dignity and
good medical practice within the scope of
this paper, the distinction and principle in-
dicate how different reasonable comprehen-
sive views can be accommodated within free
and democratic societies.
First, setting aside the case of objective er-
ror established on the basis of the facts of
a particular case, while one can affirm an
ethical obligation to do what one believes to
be right, it would be incoherent to posit an
ethical obligation to do what one believes
to be wrong.
Second, preservative freedom of conscience
requires less of society than perfective
freedom, and the effects of its suppression
more serious. Thus, much more substantial
grounds are required to justify its suppres-
sion, and in the event of conflict, preserva-
tive freedom of conscience must take pre-
cedence.
Third, suppression of preservative freedom
of conscience that also violates the principle
against servitude is unacceptable.
A WMA Protection of
Conscience Policy
There is clearly a need for a WMA preserva-
tive freedom of conscience policy consistent
with physicians’ traditional and undisputed
obligations to their patients, including du-
ties of respect, care and non-abandonment.
The goal is to protect physician integrity in
relation to the moral and medical character
of their actions, not the character or charac-
teristics of patients. This will help to ensure
that patients will be cared for by physicians
whom they know are “free to make clinical
and ethical judgements without any outside
interference” [49].
Preservative freedom of conscience should
be protected in relation to all procedures,
services and acts contested on the basis of
reasonable comprehensive views, even views
supported by the state or the medico-legal
establishment. A procedure-specific policy
is unsatisfactory in principle and not realis-
tic in view of ethical challenges continually
arising from rapid biotechnological devel-
opments, some bordering on science fiction
[50, 51]. Existing WMA policies demon-
strate that it will never be possible to de-
velop a complete and universally acceptable
list of morally contested procedures and
services [52, 53, 54, 55, 56].
A succinct and general statement in the
International Code of Medical Ethics should
reinforce the principle that physicians have
a duty to resist and refuse to participate in
acts that can reasonably be construed as
harmful to patients, a principle already re-
flected in WMA policy [57, 58]. Former
WMA Director of Ethics Dr. John R. Wil-
liams has suggested,“A physician should re-
sist all attempts by governments, regulators
and patients to force him/her to perform or
facilitate actions to which he/she has a well-
founded and defensible conscientious ob-
jection” [59]. To this we would add, “while
continuing to provide necessary treatment
and care unrelated to the morally contested
action.To ensure the health of the patient is
not endangered”.
A general ICME statement should be
supplemented by guidance to help physi-
cians defend their personal and professional
integrity while providing medical services
within the context of patient-centred prac-
tice. Guidance should support physicians
resisting not only direct personal provision
of morally contested services or procedures,
but also other forms of involvement ac-
knowledged by the WMA to be morally
relevant: referral [2], countenancing, con-
doning, facilitating or aiding [59, 60], pro-
Declaration of Geneva CANADA
BACK TO CONTENTS
45
viding skills, premises, supplies, substances
or knowledge, including individual health
information [60], planning, instruction or
training [61], preparation of reports [62]
and retrospectively affirming or supporting
unethical practices [55, 63].
An ICME statement and guidance of this
kind would be fully consistent with the
origins and purpose of the Declaration of
Geneva. The authors of the Declaration un-
derstood that human dignity is safeguarded
when physicians resist attempts to compel
them to do what they believe to be wrong.
They would never have set conscience in op-
position to good medical practice. Neither
should we.
References
1. Parsa-Parsi RW. The Revised Declaration of
Geneva: A Modern-Day Physician’s Pledge.
JAMA [Internet]. 2017 Nov 28 [cited 2020
Oct 01]; 318(20):1971-1972. Available from:
https://jamanetwork.com/journals/jama/fullar-
ticle/2658261.
2. WMA Declaration on Euthanasia and Phy-
sician-Assisted [Internet]. [Ferney-Voltaire,
France]: World Medical Association; 2019 Nov
13 [cited 2020 Oct 01]. Available from: https://
www.wma.net/policies-post/declaration-on-
euthanasia-and-physician-assisted-suicide/.
3. International Relations: War Crimes. BMJ
[Internet]. 1947 Jun 21 [cited 2020 Oct 01];
1(4406): S131. Available from: https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC2053513/
pdf/brmedj03786-0043.pdf#page=5.
4. Dworzeki M. “Let Us Throw the Anathema
Against the Murderer Doctors” September 30
1947 [Internet]. Independence, MO: Harry S.
Truman Library and Museum. [cited 2020 Oct
01]. 4 p. Available from: https://www.truman-
library.gov/library/research-files/report-mark-
dworzecki-let-us-throw-anathema-against-
murderer-doctors.
5. World Medical Association. BMJ [Internet].
1947 Dec 27 [cited 2020 Oct 01]; 2(4538):
S165-166. Available from: https://www.ncbi.
nlm.nih.gov/pmc/articles/PMC2056440/pdf/
brmedj03761-0051.pdf#page=2.
6. Crimes de Guerre et Medecine (Amendment du
document C.2/48 tel qu’adopte par l’Assemblee
Generale, September 1948) La Trahison Alle-
mande et un Re-Expose de l’Ethique Medicale.
In:Noyer F. Du syndicalisme médical de l’entre-
deux guerres à la naissance de l’Association
Médicale Mondiale : Vie et oeuvre du docteur
Paul CIBRIE.These Presentee pour le Diplome
de Docteur en Medecine. Annex 3. [Internet].
2016 [cited 2020 Oct 01]. 349 p. University
of Strasbourg. Available from: https://dhvs.
unistra.fr/fileadmin/uploads/websites/dhvs/
Recherche/2016_Noyer_Fabrice_Paul_Cibrie.
pdf#page=338.
7. Alexander LJ. Medical Science Under Dicta-
torship. N Engl J Med 1949; 241:39-47. DOI:
10.1056/NEJM194907142410201.
8. Odlum DM. World Medical Association. BMJ
[Internet]. 1947 Jul 19 [cited 2020 Oct 01];
2(4515): 108. Available from: https://www.ncbi.
nlm.nih.gov/pmc/articles/PMC2055254/pdf/
brmedj03738-0028b.pdf.
9. Morsink J.The Universal Declaration of Human
Rights: Origins, Drafting and Intent. Philadel-
phia: University of Pennsylvania Press; 1999.
10. Professor Lydia H. Liu on Human Rights Pio-
neer and Columbia alum P.C. Chang [Internet].
New York: Columbia University East Asian
Institute; 2014 [cited 2020 Oct 01]. Avail-
able from: https://weaicolumbia.wordpress.
com/2014/07/07/professor-lydia-h-liu-on-
human-rights-pioneer-and-columbia-alum-p-
c-chang/.
11. Tsai DF. The bioethical principles and Confu-
cius’ moral philosophy. J Med Ethics [Internet].
2005 [cited 2020 Oct 01]; 31:159-163.Available
from: https://jme.bmj.com/content/31/3/159.
info.
12. Qui R. The legacy of the Nuremberg Code and
the approach to bioethics in Mainland China.
In: Czech H, Druml C, Weindling P, editors.
Medical Ethics in the 70 Years after the Nurem-
berg Code: 1947 to the Present. International
Conference at the Medical University of Vi-
enna; 2017 Mar 2-3. Central European J Med
(2018) [cited 2020 Oct 01]; 130, S225 – 228.
Available from: https://link.springer.com/con-
tent/pdf/10.1007/s00508-018-1343-y.pdf.
13. World Medical Association. Declaration of
Geneva [Internet]. [Ferney-Voltaire, France]:
World Medical Association; 2018 Jul 09 [cited
2020 Oct 01]. Available from: https://www.
wma.net/policies-post/wma-declaration-of-
geneva/.
14. Maddock JW. Humanizing health care services.
The practice of medicine as a moral enterprise.
J Natl Med Assoc [Internet]. 1973 Nov [cited
2020 Oct 01]; 65(6): 500 – 504. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC2609038/pdf/jnma00496-0077.pdf.
15. Neal M, Fovargue S. Conscience and agent-in-
tegrity:a defence of conscience based exemptions
in the health care context. Med Law Rev [Inter-
net].2016 Dec 8 [cited 2020 Oct 01]; 24(4): 544
– 570. Available from: https://academic.oup.
com/medlaw/article-pdf/24/4/544/10020524/
fww023.pdf.
16. Maritain J.The Person and the Common Good.
Fitzgerald JJ, translator. Notre Dame, Indiana:
University of Notre Dame Press; 2002. 105 p.
17. King Jr ML. Three Dimensions of a Complete
Life (Sermon delivered at New Covenant Bap-
tist Church, Chicago, Illinois, 9 April 1967)
[Internet]. Stanford, California: Stanford
University Martin Luther King Jr. Research
and Education Institute [cited 2020 Oct 01].
Available from: https://kinginstitute.stanford.
edu/king-papers/documents/three-dimensions-
complete-life-sermon-delivered-new-covenant-
baptist-church.
18. King Jr ML. Rediscovering Lost Values (Ser-
mon delivered at 2nd Baptist Church,Detroit 28
February 1954) [Internet]. Stanford, California:
Stanford University Martin Luther King Jr. Re-
search and Education Institute online: Stanford
University,The Martin Luther King Jr. Research
and Education Institute [cited 2020 Oct 01].
Available from: https://kinginstitute.stanford.
edu/king-papers/documents/rediscovering-lost-
values-0.
19. Williams JR.World Medical Association Medi-
cal Ethics Manual, 3rd edition 2015. [Internet].
[Ferney-Voltaire, France]: World Medical As-
sociation; 2020 [cited 2020 Oct 01]. Available
from: https://www.wma.net/wp-content/up-
loads/2016/11/Ethics_manual_3rd_Nov2015_
en.pdf.
20. Hanson Stephen S. Moral Acquaintances
and Moral Decisions: Resolving Moral Con-
flicts in Medical Ethics [Internet]. Neth-
erlands: Springer, 2009 [cited 2020 Oct
01]. Available from: https://books.schol-
arsportal.info/uri/ebooks/ebooks0/spring-
er/2010-04-28/2/9789048125081.
21. Rawls J. Political Liberalism: Expanded Edition.
New York: Columbia University Press; 2005.
490 p.
22. Discussion follows the first introduction and
development of the distinction in Murphy S,
Genuis SJ. Freedom of Conscience in Health
Care: Distinctions and Limits. J Bioethical In-
quiry [Internet]. 2013 Jun 21 [cited 2020 Oct
01]; 10(3): 347-354. Available from: https://
link.springer.com/article/10.1007/s11673-013-
9451-x.
23. Bernard R. Coping with physician depression
in the era of Covid-19. Medical Economics
[Internet]. 2020 May 1 [cited 2020 Oct 01].
Available from: https://www.medicaleconom-
ics.com/view/coping-physician-depression-era-
covid-19.
24. Lesvos: Greece denies healthcare to sick chil-
dren in Moria camp [Internet]. Toronto:
Declaration of Geneva
CANADA
BACK TO CONTENTS
46
­
Doctors Without Borders/Médecins Sans Fron-
tières (MSF) Canada; 2020 Jan 24 [cited 2020
Oct 01]. Available from: https://www.doctors-
withoutborders.ca/article/lesvos-greece-denies-
healthcare-sick-children-moria-camp.
25. ‘Stop the attacks’: MSF president Joanne Liu
calls on members of UN Security Council to
protect civilians and hospitals in war zones
[Internet]. Toronto: Doctors Without Borders/
Médecins Sans Frontières (MSF) Canada; 2016
May 4 [cited 2020 Oct 01] Available from:
https://www.doctorswithoutborders.ca/article/
stop-attacks-msf-president-joanne-liu-calls-
members-un-security-council-protect-civilians.
26. Canadian Medical Association. 147th General
Council Delegates’ Motions: End-of-Life Care:
Motion DM 5-6 [Internet]. Powell River: Pro-
tection of Conscience Project; 2014 Aug 15 [cit-
ed 2020 Oct 01]. Available from: https://www.
consciencelaws.org/archive/documents/cma-
cmaj/2014-08-15-cma-delegate-motions.pdf.
27. Barker ET, Mason MH. The Insane Crimi-
nal as Therapist. The Canadian Journal of
Corrections 10(4) 1968 [cited 2020 Oct 01].
p.553.Available from: https://heinonline.org/
HOL/LandingPage?handle=hein.journals/
cjccj10&div=69&id=&page=
28. Barker v Barker, 2020 ONSC 3746 [Internet].
Ottawa: Canadian Legal Information Institute;
2020 [cited 2020 Oct 01]. Available from: htt-
ps://www.canlii.org/en/on/onsc/doc/2020/2020
onsc3746/2020onsc3746.pdf.
29. World Medical Association. World Medical
Association Condemns Barbaric Punishment
(news release). [Internet]. 2020 Sep 25 [cited
2020 Oct 01]. Available from: https://www.
wma.net/news-post/world-medical-associa-
tion-condemns-barbaric-punishment/.
30. Oderberg DS. Freedom of Conscience in UK
Health Care: Time for a Change? In: Freedom
of Conscience: A Comparative Law Perspective.
Bilcharz G, editor. Warsaw: Instytut Wymiaru
Sprawiedliwości; 2019.
31. Oderberg DS. Freedom of Conscience in Scan-
dinavian Health Care: The Good, The Bad and
The Ugly. In: Freedom of Conscience: A Com-
parative Law Perspective. Bilcharz G, editor.
Warsaw: Instytut Wymiaru Sprawiedliwości;
2019.
32. Julyan TE. Access to Appointments: The Ef-
fect of Discrimination on Careers.The Future of
Obstetrics and Gynaecology: The Fundamental
Right To Practice and be Trained According
to Conscience. World Federation of Catholic
Medical Associations (FIAMC) and MaterCare
International (MCI) 2001 Jun 17 – 20; Rome
[cited 2020 Oct 01]. Available from: https://
www.consciencelaws.org/repression/repres-
sion028.aspx.
33. Murphy S. South African nurse denied position
[Internet]. Powell River, BC: Protection of Con-
science Project; 2004 [updated 2006 Oct 2, cited
2020 Oct 01]. Available from: https://www.con-
sciencelaws.org/repression/repression037-001.
aspx.
34. Philippines bill launches attack on freedom of
conscience: House Bill 3773 would punish con-
scientious objection with imprisonment [Inter-
net].Powell River,BC: Protection of Conscience
Project; 2005 Apr [cited 2020 Oct 01].Available
from: https://www.consciencelaws.org/repres-
sion/repression041-001.aspx.
35. European Center for Law and Justice. Spain vio-
lates conscientious freedom of medical practition-
ers (news release) [Internet]. 2011 Jul 23 [cited
2020 Oct 01]. Available from: https://www.con-
sciencelaws.org/repression/repression056.aspx.
36. Leiva R, Cottle MM, Ferrier C, Harding SR,
Lau T, Scott JF. Euthanasia in Canada: A Cau-
tionary Tale. World Med J [Internet]. 2018
Sep [cited 2020 Oct 01]; 64:3 17-23. Available
from: https://www.wma.net/wp-content/up-
loads/2018/10/WMJ_3_2018-1.pdf#page=19.
37. Herx, L, Cottle MM, and Scott JF. The “Nor-
malization” of Euthanasia in Canada: the Cau-
tionary Tale Continues.World Med J [Internet].
2020 Apr [cited 2020 Oct 01]; 66:2 28 – 37.
Available from: https://www.wma.net/wp-con-
tent/uploads/2020/04/wmj_2_2020_WEB.
pdf#page=30.
38. Ontario, Legislative Assembly, Standing Com-
mittee on Finance and Economic Affairs,“Med-
ical Assistance in Dying Statute Law Amend-
ment Act 2017”. In Official Report of Debates
(Hansard) 41st Parl, 2nd Sess, No F-16: Dr. El-
len Warner (2017 Mar 23) [cited 2020 Oct 01].
Available from: https://www.ola.org/en/legis-
lative-business/committees/finance-economic-
affairs/parliament-41/transcripts/committee-
transcript-2017-mar-23#P1025_246018.
39. Stoker HG. Conscience: Phenomena and Theo-
ries. Blosser PE, translator. Notre Dame, IND:
University of Notre Dame Press; 2018. 378 p.
40. Ontario, Legislative Assembly, Standing Com-
mittee on Finance and Economic Affairs,“Med-
ical Assistance in Dying Statute Law Amend-
ment Act 2017”. In Official Report of Debates
(Hansard) 41st Parl, 2nd Sess, No F-17: Dr. Na-
talia Novosedlik (2017 Mar 30) [cited 2020 Oct
01]. Available from: https://www.ola.org/en/
legislative-business/committees/finance-eco-
nomic-affairs/parliament-41/transcripts/com-
mittee-transcript-2017-mar-30#P734_184776.
41. King ML Jr. “Where Do We Go From Here?”
Address Delivered at the Eleventh Annual
SCLC Convention, Atlanta, Georgia (?) 16 Au-
gust, 1967(?) [Internet]. Stanford CA: Stanford
University – The Martin Luther King Jr. Re-
search and Education Institute [cited 2020 Oct
01]. Available from: https://kinginstitute.stan-
ford.edu/king-papers/documents/where-do-
we-go-here-address-delivered-eleventh-annual-
sclc-convention.
42. Kant I. Fundamental Principles of the Meta-
physic of Morals [Internet]. Salt Lake City,
Utah: Project Gutenberg; 2004 May 1 [cited
2020 Oct 01]. Available from: http://www.
gutenberg.org/ebooks/5682.
43. Maritain J.The Rights of Man and Natural Law.
Anson DC,translator.New York: Gordian Press;
1971. 118 p.
44. Joad CEM. Guide to the Philosophy of Morals
and Politics. London: Gollancz Ltd; 1938.
45. Lewis CS.The Humanitarian Theory of Punish-
ment. In Hooper W, ed, C.S. Lewis: First and
Second Things. Glasgow: William Collins &
Sons; 1985. 128 p.
46. Wojtyla K. Love and Responsibility. San Fran-
cisco: Ignatius Press; 1993. 319 p.
47. R v Morgentaler [1988] 1 SCR 30,1988 CanLII
90 (SCC) [Internet]. Ottawa: Canadian Legal
Information Institute; 2020 [cited 2020 Oct 01].
Available from: https://www.canlii.org/en/ca/
scc/doc/1988/1988canlii90/1988canlii90.html.
48. R v Hess; R v Nguyen [1990] 2 SCR 906, 1990
CanLII 89 (SCC) [Internet]. Ottawa: Canadian
Legal Information Institute; 2020 [cited 2020
Oct 01]. Available from: https://www.canlii.org/
en/ca/scc/doc/1990/1990canlii89/1990canlii89.
html.
49. WMA Declaration of Lisbon on the Rights of
the Patient [Internet]. [Ferney-Voltaire, France]:
World Medical Association; 2018 Aug 07 [cited
2020 Oct 01]. Available from: https://www.
wma.net/policies-post/wma-declaration-of-
lisbon-on-the-rights-of-the-patient/.
50. Fourtane S. Neuralink: How the Human Brain
Will Download Directly from a Computer.Inter-
esting Engineering [Internet] 2018 Sep 02 [cited
2020 Oct 01] Available from: https://interestin-
gengineering.com/neuralink-how-the-human-
brain-will-download-directly-from-a-computer.
51. Newton C. Brain-computer interfaces are devel-
oping faster than the policy debate around them.
The Verge [Internet]; 2019 Jul 31 [cited 2020
Oct 01]. Available from: https://www.theverge.
com/interface/2019/7/31/20747916/facebook-
brain-computer-interface-policy-neuralink.
52. World Medical Association. WMA Statement
on Assisted Reproductive Technologies [Inter-
net]. [Ferney-Voltaire, France]: World Medical
Association; 2017 Feb 15 [cited 2020 Oct 01].
Available from: https://www.wma.net/policies-
post/wma-statement-on-assisted-reproductive-
technologies/.
53. World Medical Association. WMA Declaration
of Taipei on Ethical Considerations regarding
Declaration of Geneva CANADA
BACK TO CONTENTS
47
Health Databases and Biobanks [Internet]. [Fer-
ney-Voltaire, France]: World Medical Associa-
tion; 2017 Mar 21 [cited 2020 Oct 01]. Available
from: https://www.wma.net/policies-post/wma-
declaration-of-taipei-on-ethical-considerations-
regarding-health-databases-and-biobanks/.
54. World Medical Association. WMA Declara-
tion of Taipei on Organ and Tissue Donation
[Internet]. [Ferney-Voltaire, France]: World
Medical Association; 2017 Oct 17 [cited 2020
Oct 01]. Available from: https://www.wma.net/
policies-post/wma-statement-on-organ-and-
tissue-donation/.
55. World Medical Association.WMA Declara-
tion on Medical Ethics and Advanced Medi-
cal Technology [Internet]. [Ferney-Voltaire,
France]: World Medical Association; 2017 Feb
14 [cited 2020 Oct 01]. Available from: https://
www.wma.net/policies-post/wma-declaration-
on-medical-ethics-and-advanced-medical-
technology/.
56. World Medical Association. WMA Resolution
on the Non-Commercialisation of Human Re-
productive Material [Internet]. [Ferney-Voltaire,
France]: World Medical Association; 2017 Feb
17 [cited 2020 Oct 01]. Available from: https://
www.wma.net/policies-post/wma-resolution-
on-the-non-commercialisation-of-human-re-
productive-material/.
57. World Medical Association. WMA Resolution
on the Abuse of Psychiatry [Internet]. [Ferney-
Voltaire, France]: World Medical Association;
2017 Feb 14 [cited 2020 Oct 01]. Available
from: https://www.wma.net/policies-post/wma-
resolution-on-the-abuse-of-psychiatry/.
58. WMA Declaration of Hamburg Concerning
Support for Medical Doctors Refusing to Par-
ticipate in, or to condone, the use of Torture and
other Cruel, Inhuman or Degrading Treatment
[Internet]. [Ferney-Voltaire, France]: World
Medical Association; 2020 Jul 20 [cited 2020
Oct 01]. Available from: https://www.wma.net/
policies-post/wma-declaration-of-hamburg-
concerning-support-for-medical-doctors-refus-
ing-to-participate-in-or-to-condone-the-use-
of-torture-or-other-forms-of-cruel-inhuman-
or-degrading-treatment/.
59. Williams JR. [Internet]. Email Message to Rene
Leiva. 2020 Sep 20 [cited 2020 Sep 30].
60. WMA Declaration of Tokyo- Guidelines for
Physicians Concerning Torture and other Cruel,
Inhuman or Degrading Treatment or Punish-
ment in Relation to Detention and Imprison-
ment [Internet]. [Ferney-Voltaire, France]:
World Medical Association; 2020 May 25 [cited
2020 Oct 01]. Available from: https://www.
wma.net/policies-post/wma-declaration-of-to-
kyo-guidelines-for-physicians-concerning-tor-
ture-and-other-cruel-inhuman-or-degrading-
treatment-or-punishment-in-relation-to-de-
tention-and-imprisonment/.
61. World Medical Association. WMA Resolution
on the Prohibition of Physician Participation
in Capital Punishment [Internet]. [Ferney-
Voltaire, France]: World Medical Association;
2018 Oct 06 [cited 2020 Oct 01]. Available
from: https://www.wma.net/policies-post/wma-
resolution-on-prohibition-of-physician-partici-
pation-in-capital-punishment/.
62. WMA Resoluton on Prohibition of Forced Anal
Examinations to Substantiate Same-Sex Sexual
Activity [Internet]. [Ferney-Voltaire, France]:
World Medical Association; 2017 Oct 17 [cited
2020 Oct 01]. Available from: https://www.
wma.net/policies-post/wma-resolution-on-
prohibition-of-forced-anal-examinations-to-
substantiate-same-sex-sexual-activity/.
63. World Medical Association. WMA Statement
on Organ and Tissue Donation [Internet]. [Fer-
ney-Voltaire, France]: World Medical Associa-
tion; 2020 Aug 21 [cited 2020 Oct 01].Available
from: https://www.wma.net/policies-post/wma-
statement-on-organ-and-tissue-donation/.
(Institutional affiliation are provided for iden-
tification purposes only and do not imply en-
dorsement by the institution)
Sean Murphy,
Administrator
Protection of Conscience Project
British Columbia
Canada.
Dr. Ramona Coelho,
MDCM, CCFP
Dr. Philippe D. Violette,
MSc. MDCM, FRCSC
Assistant Professor Depts. of Surgery
and Health Research Methods,
Evidence and Impact,
McMaster University, Hamilton,
Ontario, Canada.
Ewan C Goligher,
MD PhD
Assistant Professor
Interdepartmental Division of
Critical Care Medicine
University of Toronto
Timothy Lau,
MD, FRCPC
Distinguished Teacher,
Associate Professor,
Faculty of Medicine, Department
of Psychiatry,
Geriatrics, Royal Ottawa Hospital.
Sheila Rutledge Harding,
MD, MA, FRCPC
Hematology
Saskatchewan Health Authority
Professor, University of Saskatchewan
Saskatoon, Saskatchewan,
Canada
Rene Leiva,
MD CM; CCFP, FCFP
Assistant Professor
Department of Family Medicine
University of Ottawa
Ottawa, ON, Canada
Declaration of Geneva
CANADA
BACK TO CONTENTS
48
WHO News
The World Health Organization (WHO)
Fifty-fifth Expert Committee on Specifica-
tions for Pharmaceutical Preparations (EC-
SPP) Special Session with non-State actors,
coordinated from WHO headquarters, was
held virtually on October 6, 2020. Accord-
ing to the invitation from Dr. Mariângela
Simão, Assistant Director General of the
WHO, Access to Medicines, Vaccines and
Pharmaceuticals, on behalf of Dr. Tedros
Adhanom Ghebreyesus, Director General
of the WHO, many representatives nomi-
nated by their organizations attended from
all over the world. Thanks to the nomina-
tion by the World Medical Association
(WMA), I participated in this great session.
Dr. Sabine Kopp, Team Lead of Norms
and Standards for Pharmaceuticals, Health
Products Policy and Standards Department
of the WHO, who chaired the session, in-
troduced current activities associated with
the ECSPP covering norms and standards
for pharmaceuticals, including medicines
quality assurance, regulatory guidance, good
practices, WHO model schemes and qual-
ity control specifications.
The ECSPP, an expert committee of the
WHO, covers Norms and Standards for
Pharmaceuticals: development, production,
quality control, regulatory standards, in-
spection, distribution and supply. The EC-
SPP offers about 170 current official WHO
guidance texts and guidelines for medicines
quality assurance and regulatory standards.
Those guidance texts and guidelines were
developed in response to recommendations
and requests by WHO Governing Bodies,
WHO Programmes or in response to major
public health needs, following strict rules
and procedures. Reviewed by expert groups
and discussed in annual Expert Committee
meetings, those texts would be adopted by
the ECSPP, and recommended to Member
States.
In my opinion, the process of developing
guidance texts and guidelines by the EC-
SPP is similar to that of developing policies,
aiming ‘to serve humanity by endeavoring to
achieve the highest international standards
in Medical Education, Medical Science,
Medical Art and Medical Ethics,and Health
Care for all people in the world’ [1], by the
WMA as the global representative voice
of physicians. As the representative to the
General Assembly of the WMA, I strongly
feel the importance of experts’ discussions
and communications, including us, health-
care professionals. Besides, I’d like to refer
to the fantastic messages from Dr. Jacques
de Haller, Former President of the Standing
Committee of European Doctors (CPME)
and the Swiss Medical Association (FMH):
‘I think it is most effective when groups are
challenged by their own members. I mean, if
doctors speak to patients or if they speak to
students, they can be felt as paternalistic. If
students speak to patients,they are not expe-
rienced. So, if patients’ organisations speak
to patients and if doctors speak to their col-
leagues knowing what they feel, think and
how they reflect about it, the communica-
tion can be more efficient’[2].
A wonderful presentation regarding
­COVID-19 related activities by the ECSPP
was given as a technical agenda of the Fifty-
fifth ECSPP. Many topics were raised, in-
cluding specifications of oxygen, dexameth-
asone, dexamethasone phosphate injection,
dexamethasone tablets, and remdesivir. As
the matters of guidelines and guidance
texts, compilation of relevant WHO guid-
ance for SARS-CoV2 COVID-19 treat-
ment, review and revision of existing WHO
guidelines and guidance texts including
WHO Good Manufacturing Practice for
investigational pharmaceutical products for
clinical trials in humans, WHO guidelines
on transfer of technology in pharmaceuti-
cal manufacturing, and GMP guideline
on the required practices during research
and development of medical products were
pointed out. In addition, the issues about
‘biowaiver’ studies were discussed.
I supposed that the main effect of
­
COVID-19 pandemic would be the esca-
lation of inequities and injustice that exist
due to the pandemic, but then I was told
that I was nominated for the COVID-19
Educational Award, Harvard University. It
would be the time to make full use of the
principles prepared before the pandemic,for
example, the WMA Declaration of Helsin-
ki (DOH) as an ethical guide for research
involving human participants in clinical
trials. It would be great if the DOH were
The World Health Organization Fifty-fifth Expert Committee
on Specifications for Pharmaceutical Preparations Special Session
with non-State Actors. Virtual, 6 October 2020
Rui Nakamura
JAPAN
BACK TO CONTENTS
III
WHO News
spoken about more. We can refer to the ex-
cellent article [3] describing the process of
the DOH revision in 2013 by Dr. Cecil B.
Wilson, Past President of the WMA and
the American Medical Association (AMA).
I think it is essential ‘to involve in discus-
sions those physicians not familiar with the
work of WMA and thereby increase the
visibility of the association’ [4] commented
by Dr. Jon Snaedal, Past President of the
WMA and the Icelandic Medical Associa-
tion.As Dr.Joe Heyman,Chair of Associate
Membership of the WMA, Former Chair
of the AMA Board of Trustees, and Former
President of the Massachusetts Medical
Society, kindly mentioned in his outstand-
ing article, the Japan Medical Association
published part of the WMA Journal in its
own journal and spread it among all Japa-
nese medical students and physicians along
with an appeal for associate membership of
the WMA [5].
When I wrote the first chapter of a text-
book, published in 2018 by Oxford Univer-
sity Press, regarding clinical research and
medical ethics, I quoted the golden and
everlasting saying of Stephen W. Hawk-
ing,an English theoretical physicist,written
in his best-seller A Brief History of Time as
the epigraph: ‘‘The whole history of science
has been the gradual realization that events
do not happen in an arbitrary manner, but
that they reflect a certain underlying order,
which may or may not be divinely inspired.’’
I hope and am sure the discussion regard-
ing COVID-19 pandemic in that session
contributes to the history of science, clinical
trials and medical ethics. Moreover, I’d like
to remind of the critical message, ‘In reality,
the practical issues tend to override patient
rights. This needs to be kept in mind’ [6]
said by Dr. Jon Snaedal in his outstanding
lecture in Japan several years ago.
As another technical agenda, international
pharmacopoeia including the monograph
development process was introduced. The
main features of the monograph develop-
ment process are: designed to ensure wide
consultation and transparency; governed by
publicly available rules and procedures, for
example, ‘schedule for the adoption process’
outlining the development history is includ-
ed in each working document; foreseeing
continuous revision of methods and specifi-
cations to reflect advances in analytical sci-
ence and regulatory requirements; allowing
participation of all interested parties; apply-
ing conflict of interest and confidentiality
rules.We would learn a lot from the chapter
[7] regarding confidentiality written by Dr.
Raanan Gillon, Immediate Past President
of the British Medical Association, and Dr.
Daniel K. Sokol.
After closing the successful session, I felt
the importance of the perspectives of phy-
sicians/clinicians in every aspect dealt with
there. I believe the more we participate, the
more we contribute to the WMA’s sublime
mission.
Lastly, I am grateful to Ms. Claire Vo-
gel, NSP at the WHO, Ms. Anne-Marie
Delage, Secretary of the WMA, and Dr.
Otmar Kloiber, Secretary General of the
WMA, for their generous support.
References
1. The World Medical Association. (2020). What
is its mission? Accessed 5 December 2020, from
https://www.wma.net/who-we-are/about-us/.
2. Haller, JD., Alexandrou, M. (2017). Interview
with CPME President, Dr. Jacques de Haller.
Accessed 5 December 2020, from https://emsa-
europe.eu/2017/11/15/interview-with-cpme-
president-dr-jacques-de-haller/.
3. Wilson, CB. (2013). An updated Declaration of
Helsinki will provide more protection. Nat Med.
Jun;19 (6):664. doi: 10.1038/nm0613-664.
4. Snaedal, J. (2019). The WMA Medical Ethics
Conference. World Medical Journal. 65(1):2-3.
5. Heyman, J. (2018). Associate Membership –
Past, Present and Future. World Medical Jour-
nal. 64(1):3-5.
6. Snaedal, J. (2014). Centralized health data-
bases: lessons from Iceland. Japan Med Assoc J.
57(2):68-74.
7. Gillon, R., Sokol, DK. (2009). Confidentiality.
In A Companion to Bioethics: Second Edition.
eds. Kuhse, H. and Singer, P., 513-29. West Sus-
sex: Wiley-Blackwell, John Wiley & Sons.
Rui Nakamura, MD
Representative to the General Assembly,
The World Medical Association
The Japan Medical Association
JAPAN
BACK TO CONTENTS
IV
General Assembly Report
Official Letter to the World
Medical Journal
We regrettably received the political hostile comment of two
Canadian politicians on the development of organ transplan-
tation and national policies in China. This comment is in the
same form of the conspiracy theory that the authors propagan-
dized during last decade, in the attempt to disguise as academic
paper, but filled with non-scientific misconduct (self-citation,
confusing circular logic, invalid reference, personal attack).The
two David ignored the basic facts of the development of organ
transplantation in China and insisted on smearing and slander-
ing the development of China with unconfirmed evidence. In
fact, as described in the article The Reform Process of Organ Do-
nation and Transplantation in China, the Chinese government
has repeatedly discussed the history and development of organ
transplantation in China since 2005 [1, 2]. In response to in-
ternational doubts about organ donation and transplantation in
China, the Washington Post made a detailed introduction to the
development and history of organ transplantation in China by
citing authoritative evidence in 2017[1].The content is informa-
tive and credible,and it is also for most rational readers.In recent
years, the development of organ transplantation in China has
been officially recognized by international transplant scientific
community, such as the World Health Organization (WHO),
The Transplant Society (TTS), Pontifical Academy of Science
[2, 3, 4]. The two David attempted to extend the political at-
tack and discredit on China to the academic field. To this end,
we resolutely oppose politicizing academic issues and publish-
ing letters of fabrication from two Canadian politicians in the
World Medical Journal.
Regarding the part of the letter concerning Professor Shi Bingyi’s
personal remarks, we have thoroughly verified with Professor Shi
Bingyi.Professor Shi Bingyi’s statement is as follows: “As the two
David said in their letters, I have responded many times through
various channels (8,9 Phoenix TV and JAMA). I personally did
not mentioned the number of organ transplants in China on any
occasion. In view of the fact that the two David didn’t put for-
ward any new evidence, and all the evidence was in 2007, I won’t
make any new response. The figures of organ transplantation in
China before 2007 that David paid attention to can refer to Pro-
fessor Huang Jiefu’s report published in Lancet magazine [2] and
Washington Post’s report on the development of organ trans-
plantation in China [1].
We have always maintained an open attitude and responded
positively to the challenges and criticisms from the interna-
tional community, especially from the international transplant
community, regarding organ transplantation in China. Professor
Huang Jiefu has published a series of articles, comments, etc.,
introducing the reform and current situation in the field of organ
transplantation in China. As we pointed out in the article, the
reform and development of organ transplantation in China can-
not be separated from international wisdom, and we have always
welcomed the help of international transplant experts in organ
transplantation reform in China. In recent years, the reform in
the field of organ transplantation in China has been recognized
by leading members of international transplant and scientific
communities. Many experts who are skeptical about China have
also personally visited China and witnessed the process of or-
gan donation and transplantation in China, thus changing their
negative attitude towards China. The two Canadian politicians
have never conducted any field investigation on organ dona-
tion and transplantation in China. Although they are extremely
concerned about China’s negative information, the information
they have received is hearsay information or even deliberately
fabricated lies.
The direct evidence from many international experts of WHO,
TTS and PAS, who visited China and witnessed the reform and
development of organ transplantation in China, has been delib-
erately and selectively ignored by the group headed by the two
Canadian politicians.
In summary,we oppose the letter of political comments from two
Canadian politicians with vinous of scientific misconducts to be
published in any academic journal. Professor Shi Bingyi has re-
peatedly responded the unfounded accusation from 13 years ago
in various forms and on various occasions. China will strengthen
and enlarge the exchanges & cooperation with the international
transplant communities, continue to strive to build an ethical or-
gan transplantation system in line with WHO guiding principles
and contribute “Chinese Wisdom”to the progress of organ trans-
plantation in the world.
Sincerely,
Rao Keqin
Vice President and Secretary General of Chinese Medical Association
References
1. Simon Denyer. (2017). China used to harvest organs from prisoners.
Under pressure, that practice is finally ending. https://www.washing-
tonpost.com/world/asia_pacific/in-the-face-of-criticism-china-has-
been-cleaning-up-its-organ-transplant-industry/2017/09/14/d689444e-
e1a2-11e6-a419-eefe8eff0835_story.html
2. New era for organ donation and transplant in China. Wang H. Bull
World Health Organ. 2012. PMID: 23226891
3. The Transplantation Society Believes a Policy of Engagement Will Facili-
tate Organ Donation Reform in China. P. J. O’Connell, N. Ascher, and F.
L. Delmonico. Am J Transplant. 2016 Nov; 16(11): 3297–3298.
4. Final Declaration of the Ethics in Action Meeting: On Modern Slavery,
Human Trafficking, and Access to Justice for the Poor and Vulnerable.
CasinaPio IV, March 12-13, 2018. http://www.endslavery.va/content/
endslavery/en/eia/ht.html
5. Huang,J. , Mao,Y. , & Millis, J. M.. (2008). Government policy and organ
transplantation in china. , 372(9654), 0-1938.
6. Huang, J. , Mao, Y. , Wang, Y. , Zhang, Z. J., Zhao, M. G. , & Liu, Y.
(2008). Modernization of the organ transplantation program in china.
Transplantation, 86(12), 1649.
7. Huang J, (2007). Ethical and legislative perspectives on liver transplanta-
tion in the people’s republic of china. Liver Transplantation.
8. ShiB, ChenL, (2011) Regulation of organ transplantation in China: dif-
ficult exploration and slow advance.JAMA,2011,306(4):434-5.
9. Trey, T., Halpern, A., Singh, M. A. F. (2011). Organ Transplantation and
Regulation in China. JAMA, 2011, 306(17), 1863–1864.
10. Phoenix TV, http://phtv.ifeng.com/phinfo/200706/0628_45_144064.
shtml
BACK TO CONTENTS