WMA European Region Meeting on End-of-Life Questions

WMA European Region Meeting on End-of-Life Questions

                                                                            

On Thursday and Friday, 16-17 November 2017, medical professionals, legal authorities, experts in palliative care and medical ethics, theological scholars and philosophers from over 30 countries gathered in the Aula Vecchia del Sinodo in the Vatican for the World Medical Association European Region Meeting on End-of-Life Questions.

Hosted by the World Medical Association (WMA), the German Medical Association (GMA) and the Pontifical Academy for Life (PAV), this two-day event provided a platform for debating the different policies and perspectives on end-of-life issues in Europe, for exploring patient rights, treatment limitations, and palliative care, and for better understanding public opinion on these complex topics.

On the first day, the Congress was introduced by a meaningful and rich message from His Holiness Pope Francis, read by Cardinal Turkson, Prefect of the Dicastery for promoting integral human development. In his words, Pope Francis developed a deep reflection about the frailty of life and the need to support it with good practices. 

      

Opening remarks were also delivered by WMA President Dr Yoshitake Yokokura, GMA President Prof. Dr. Frank Ulrich Montgomery and PAV President Archbishop Msgr. Vincenzo Paglia. The program continued with a look at three different perspectives on end-of-life questions by Professor Montgomery, Dr René Héman, Chairman of the Royal Dutch Medical Association, and Dr. Yvonne Gilli, Board Member of the Swiss Medical Association.

The subsequent session highlighted insights on end-of-life questions from different religious and theological backgrounds.

Rounding out the first day of programming was a session focused on examining legal aspects of euthanasia and physician-assisted suicide, which included a contribution from Prof. Dr. Volker Lipp, Professor of Civil Law, Civil Procedure, Medical Law and Comparative Law at Georg-August-Universität. This was followed by an overview of the Council of Europe’s Guide on the decision-making process regarding medical treatment in end-of-life situations as illustrated by Dr. Laurence Lwoff, Head of the Bioethics Unit of the Council of Europe’s Human Rights Directorate, and a series of presentations, including a talk by Prof. Dr. Leonid Eidelman, President of the Israeli Medical Association, exploring various aspects of compassionate use and conscientious objection.

Day two of the conference opened with an ethical debate surrounding the question of whether there is a right to determine one’s own death, after which Dr. Anne de la Tour, President of the French Society of Palliative Care, shared her expertise on treatment limitations and end-stage decisions about sedation.

Representing the patient’s perspective was Dr. Marco Greco, President of the European Patients’ Forum, who delivered a presentation on public opinions of key end-of-life issues.

The final day closed with a plenary panel discussion featuring six speakers from Switzerland, Italy, Germany and the Netherlands, representing an extensive range of opinions and policy viewpoints. 

The in-depth discussions held over the course of the two-day conference were intended to contribute to an overarching debate on end-of-life issues recently initiated by the WMA’s Medical Ethics Committee. To capture the global scale of this debate, the WMA set out to co-organize a series of regional meetings on nearly every continent. Previous meetings have been held in Tokyo and Rio de Janeiro. The WMA African Region Meeting on this subject will take place in early 2018 in Nigeria.

(Source: WMA, November 17, 2017)

WMA policy statement on participation of doctors in executions should be implemented

WMA policy statement on participation of doctors in executions should be implemented

Dr KK Aggarwal

Should doctors participate in state executions or capital punishments? This is a very controversial issue in medical ethics.

Doctors are required to monitor vital signs during the process of execution (hanging in case of India) and look for signs of life and then pronounce death. This is against medical ethics.

Opposing the participation of doctors, the World Medical Association (WMA) came out with a “Resolution on physician participation in capital punishment” in 1981 and amended in 2008. The resolution states as follows

“RESOLVED, that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions.

The World Medical Association

REQUESTS firmly its constituent members to advise all physicians that any participation in capital punishment as stated above is unethical.

URGES its constituent members to lobby actively national governments and legislators against any participation of physicians in capital punishment”

In its general assembly in 2012, the WMA again passed a resolution reaffirming its prohibition of physician participation in capital punishment.

“There is universal agreement that physicians must not participate in executions because such participation is incompatible with the physician’s role as healer. The use of a physician’s knowledge and clinical skill for purposes other than promoting health, wellbeing and welfare undermines a basic ethical foundation of medicine—first, do no harm.

As citizens, physicians have the right to form views about capital punishment based on their individual moral beliefs. As members of the medical profession, they must uphold the prohibition against participation in capital punishment.

Therefore, be it RESOLVED that:

· Physicians will not facilitate the importation or prescription of drugs for execution.

· The WMA reaffirms: “that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions”, and

· The WMA reaffirms: that physicians “will maintain the utmost respect for human life and will not use [my] medical knowledge to violate human rights and civil liberties, even under threat.”

The WMA Declaration of Geneva or the “Modern Hippocratic Oath”, first adopted in 1948 was recently amended in October 2017 at the annual general assembly in Chicago, USA. The revised version also states: “As a member of the medical profession:

· The health and well-being of my patient will be my first consideration;

· I will maintain the utmost respect for human life

· I will not use my medical knowledge to violate human rights and civil liberties, even under threat”

This final version of the Declaration of Geneva has been accepted by all member national medical associations including the Indian Medical Association (IMA).

No doctor should be present during the process of execution. This is violation of medical ethics and is a professional misconduct.

The World Medical Association today has a membership of 112 national medical associations. IMA is a founder member of this world body. This makes India a signatory to all policies and resolutions adopted by the WMA. Hence, the WMA Resolution on Physician Participation in Capital Punishment should also be implemented in our country.

Disclaimer: The views expressed in this write up are entirely my own.

Global issues discussed during the WMA General Assembly

Global issues discussed during the WMA General Assembly

Dr KK Aggarwal

The World Medical Association (WMA) concluded its annual General Assembly in Chicago held from October 11-14. More than 50 national medical associations attended the annual General Assembly and discussed various global issues.

Dr Yoshitake Yokokura, President of the Japan Medical Association, was installed as President of the WMA for 2017-18. Dr Leonid Eidelman, President of the Israel Medical Association, was elected President elect. He will take office in a year’s time to serve as President in 2018-19.

Hunger strikes: The Assembly agreed that the WMA would support any physician who faces political pressure to take part in forced feeding of hunger strikers against their ethical advice. In a revision of its policy on hunger strikers, the WMA says that national medical associations ‘have a responsibility to make efforts to prevent unethical practices, to take a position against ethical violations, and to investigate them properly’. Delegates agreed that where physicians are pressured to take part in torture, the WMA would protest internationally and publicize information about the case.

Bullying: A policy of zero tolerance towards bullying and harassment in the medical profession was supported by the meeting. Delegates agreed a statement condemning bullying under any circumstances and encouraging all national medical associations members, medical schools, employers, and medical colleges to establish and implement anti-bullying and harassment policies.
WMA President, Dr. Yoshitake Yokokura said: ‘Bullying in the health workplace is entirely unprofessional and destructive, and should not be tolerated. It is time the profession took steps to prevent, confront, report and eliminate such behaviour at any level’.

Armed conflict: Against a background of armed conflicts in many parts of the world, the Assembly issued a strongly worded statement reminding governments of the human consequence of warfare. It says that armed conflict should always be a last resort and physicians should encourage politicians, governments, and others in positions of power to be more aware of the consequence of their decisions to start or continue armed conflict. Efforts to avoid conflicts are often insufficient and inadequate and country leaders may not seek all alternatives. Delegates stressed that avoiding war and seeking constructive alternatives is always desirable.

Access to health care: A call for ethical codes for recruiting health professionals was agreed in a bid to reduce inappropriate recruitment activities by states. The Assembly approved a new policy to combat the problems of a global maldistribution of health care workers. It declared that the global movement of workers, especially from less developed to better developed countries, is leading to continuing shortages. It said that ethical recruitment codes were needed for both governments and commercial recruitment agencies to ensure that countries did not actively recruit from other states.

Alcohol: A worldwide drink drive limit of no more than 50 milligrams per 100 millilitres of blood was called for by the Assembly in a new drive to reduce excessive alcohol consumption. In a statement, the WMA says that key deterrents should be implemented for driving while intoxicated, including a strictly enforced legal maximum blood alcohol concentration for drivers of no more than 50mg/100ml, supported by social marketing campaigns and the power of authorities to impose immediate sanctions. WMA President Dr. Yoshitake Yokokura said: ‘The human cost of drunk driving across the world is appalling. The daily tragedy of death and injury caused by drivers who drink while over the limit is unforgivable. I hope that governments will act to reduce the drink drive limit’.

Child abuse: Guidance to physicians on dealing with child abuse were agreed. In a new policy document, the WMA says that child abuse in all its forms, including exploitation of children in the labour market, is a world health problem and that physicians have a unique and special role in identifying and helping abused children and their families. All physicians should be educated about the overriding importance of the welfare of children. They should act in the best interests of children in all of their contacts with children, young people, families, policy-makers and other professionals.

Fair trade: The Assembly condemned the abuses of labour standards, evidence of modern slavery and unethical working conditions that have been uncovered in the manufacture of many medical products around the world. In a new Declaration, the WMA calls for a fair and ethical purchasing policy for medical goods. It urges all its national medical association members to advocate for human rights to be protected throughout the global supply chains of products used in their healthcare systems.

New members: Five new members were admitted – the Czech Medical Chamber, the Belarusian Association of Physicians, the Pakistan Medical Association, the National Medical Chamber of Russia and the Belize Medical and Dental Association. This increases the total number of medical associations and constituent members in the WMA to 114.

All the policies adopted by the Assembly can be found on the website of the WMA.

(Source: WMA, October 16, 2017)

Proposed Revision of the World Medical Association Declaration of Geneva: For comments and inputs

Proposed Revision of the World Medical Association Declaration of Geneva: For comments and inputs

Document no:	MEC 207/DoG/Oct2017	Original: English
Title:	Proposed Revision of the WMA Declaration of Geneva
Destination:	Constituent Members	Action(s) required: For Comments
Note:	This revised version (as of 7 June 2017) is proposed by the DoG Workgroup who considered the comments from the public consultation which was conducted for all experts and stakeholders by 29 May 2017. This is now open for the Constituent Members to comment no later than 31 July 2017.
Keywords	Geneva, Oath, Pledge, Conduct, Discrimination, Non-Discrimination, Conscience, Dignity

No	Text of current version of the Declaration of Geneva	Revised draft (as of 7 June 2017) Additions: bold/underlined Deletions:  lined-out Comments only: [italic]	Comments
	WMA DECLARATION OF GENEVA	WMA DECLARATION OF GENEVA
New		The Physician’s Oath
	Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968 and the 35th World Medical Assembly, Venice, Italy, October 1983 and the 46th WMA General Assembly, Stockholm, Sweden, September 1994 and 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	Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968 and the 35th World Medical Assembly, Venice, Italy, October 1983 and the 46th WMA General Assembly, Stockholm, Sweden, September 1994 and 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 and the
1.	AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:	AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:
2.	I SOLEMNLY PLEDGE to consecrate my life to the service of humanity;	I SOLEMNLY PLEDGE to consecrate dedicate my life to the service of humanity;
3.	I WILL GIVE to my teachers the respect and gratitude that is their due;	I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
		I WILL FOSTER MAINTAIN by all means in my power, the honour and noble traditions of the medical profession;  (Moved from line 7)
4.	I WILL PRACTISE my profession with conscience and dignity;	I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;
5.	THE HEALTH OF MY PATIENT will be my first consideration;	THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
New		I WILL RESPECT the autonomy and dignity of my patient;
6.	I WILL RESPECT the secrets that are confided in me, even after the patient has died;	I WILL RESPECT the secrets that are confided in me, even after the patient has died;
7.	I WILL MAINTAIN by all means in my power, the honour and the noble traditions of the medical profession;	Moved between lines 3 and 4 – see above
8.	MY COLLEAGUES will be my sisters and brothers;	MY COLLEAGUES will be my sisters and brothers;
New		I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
New		I WILL FOSTER my own health and ability to provide care of the highest standard;
9.	I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;	I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
10.	I WILL MAINTAIN the utmost respect for human life;	I WILL MAINTAIN the utmost respect for human life;
11.	I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;	I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
12.	I MAKE THESE PROMISES solemnly, freely and upon my honour.	I MAKE THESE PROMISES solemnly, freely and upon my honour.

Dr KK Aggarwal
National President IMA & HCFI

Proposed Revision of WMA Resolution on Tuberculosis: Inputs required

Document no:	SMAC 206/Tuberculosis REV/Apr2017	Original: English
Title:	Proposed Revision of WMA Resolution on Tuberculosis
Destination:	Constituent Members	Action(s) required: For consideration
Note:	As part of the annual policy review process, the Council in Buenos Aires (April 2016) decided that the WMA Resolution on Tuberculosis should undergo a major revision. The Indian Medical Association (IMA) volunteered to undertake that work. At its 204th session in Taipei (October 2016), the Council decided to circulate the proposed revised document within WMA membership for comments. The 206th Council session in Livingstone (April 2017) considered the revised version and decided to circulate it again within WMA membership for further comments.

PREAMBLE

1.            According to the World Health Organization, tuberculosis is a significant global public health problem affecting over 8 million cases every year with 2.2 million infectious cases and over 1.5 million deaths. South East Asian and African countries are most affected.

2.            In developing countries, the incidence of tuberculosis has risen dramatically because of high prevalence of HIV/AIDS, increasing migration of populations, urbanisation and over-crowding.

3.            The emergence of strains of tuberculosis bacteria resistant to first-line drugs have become a major public health threat in the forms of multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR TB) due to indiscriminate or inappropriate use, lack of access, poor compliance or incomplete treatment.

4.            MDR tuberculosis is a significant threat to development and the safety of global health.

5.            Community awareness and public health education and promotion are essential elements of tuberculosis prevention.

6.            Screening of high risk groups including PLHIV (people living with HIV) and vulnerable population including migrants, prisoners and the homeless is important in tuberculosis prevention.

7.            Rapid diagnosis with molecular tests and supervised daily treatment started at the earliest should help arrest the spread of disease.

8.            BCG (Bacille Calmette-Guérin) vaccination as early as possible after birth should continue until a new more effective vaccine is available.

  

RECOMMENDATIONS

8.       The World Medical Association, in consultation with WHO and national and international health authorities and organizations, will continue its work to generate community awareness about symptoms of TB and increase capacity building of health care providers in early identification and diagnosis of TB suspects and ensuring complete treatment utilizing Directly Observed Treatment Short course.

9.       The WMA supports calls for adequate financial, material and human resources for tuberculosis and HIV/AIDS research and prevention, including adequately trained health care providers and adequate public health infrastructure, and will participate with health professionals in providing information on tuberculosis and its treatment.

Health care professionals should have access to all required medical and protective equipment to prevent against the risk of infection and spread of the disease.

10.    The WMA encourages continuing efforts to build up the capacity of health care professionals about increase in the use of rapid diagnostics methods, their availability in the public sector and in the management of all forms of TB including (MDR and XDR).

11.    The WMA calls on its Member National Medical Associations to support their National TB Programmes by generating awareness among healthcare professionals about TB management and in the community for early reporting.

12.    The WMA calls on its National Member Associations to propagate methods of TB prevention including respiratory hygiene, cough etiquettes, and safe sputum disposal.

13.    National Member Associations should encourage all its members to timely notify to relevant authorities, all patients diagnosed or put on TB treatment for initiation of contact screening and adequate follow up till the completion of treatment.

14.    National Member Associations should co-ordinate with their TB National Programme and promulgate the adopted guidelines to all members.

The WMA supports WHO's efforts and call upon all governments, communities, civil society and the private sector to act together to end tuberculosis world-wide.

All should jointly promote collaboration using new innovative approaches to achieve TB free World and achieve the Sustainable Development Goals (SDGs).

Revision of Declaration of Geneva

Revision of Declaration of Geneva

IMA is currently reworking on the Declaration of Geneva through the World Medical Association (WMA). Inputs and suggestions on the draft are invited from all.

Dr KK Aggarwal

National President IMA

Text of current version of the Declaration of Geneva	Current revised text (as of 11 April 2017) SUBJECT TO CHANGE Specific Comments Additions: bold/underlined Deletions:  lined-out Comments only:[italic]	Comments
WMA Declaration of Geneva	WMA Declaration of Geneva
	The Physicians’ Oath
Adopted by the 2ndGeneral Assembly of the World Medical Association, Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968 and the 35th World Medical Assembly, Venice, Italy, October 1983 and the 46th WMA General Assembly, Stockholm, Sweden, September 1994 and 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	Adopted by the 2ndGeneral Assembly of the World Medical Association, Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968 and the 35th World Medical Assembly, Venice, Italy, October 1983 and the 46th WMA General Assembly, Stockholm, Sweden, September 1994 and 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 and the
AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:	AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE to consecrate my life to the service of humanity;	I SOLEMNLY PLEDGE to consecrate my life to the service of humanity;
I WILL GIVE to my teachers the respect and gratitude that is their due;	I WILL GIVE to my teachers, colleagues and students the respect and gratitude that is their due;
	I WILL MAINTAIN by all means in my power, the honour and noble traditions of the medical profession; (Moved from line 7)
I WILL PRACTISE my profession with conscience and dignity;	I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;
THE HEALTH OF MY PATIENT will be my first consideration;	THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
	I WILL RESPECT the autonomy and dignity of my patient;
I WILL RESPECT the secrets that are confided in me, even after the patient has died;	I WILL RESPECT the secrets that are confided in me, even after the patient has died;
I WILL MAINTAIN by all means in my power, the honour and the noble traditions of the medical profession;	Moved between lines 3 and 4 – see above
MY COLLEAGUES will be my sisters and brothers;	MY COLLEAGUES will be my sisters and brothers;
	I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
	I WILL FOSTER my own health and ability to provide care of the highest standard;
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;	I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I WILL MAINTAIN the utmost respect for human life;	I WILL MAINTAIN the utmost respect for human life;
I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;	I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly, freely and upon my honour.	I MAKE THESE PROMISES solemnly, freely and upon my honour.