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WMA Medical Ethics Manual 3rd edition 2015 2 1 WORLD MEDICAL ASSOCIATION Medical Ethics Manual World Medical Association Medical Ethics Medical Ethics Manual – Principal Features of Manual 3rd edition 2015 Medical student holding a newborn © Roger Ball/CORBIS 2 1 © 2015 by The World Medical Association, Inc. TABLE OF CONTENTS All rights reserved. Up to 10 copies of this document may be made for your non-commercial personal use, provided that Acknowledgments ...................................................................................4 credit is given to the original source. You must have prior written Foreword ........................................................................................................5 permission for any other reproduction, storage in a retrieval system or transmission, in any form or by any means. Requests Introduction ..................................................................................................7 for permission should be directed to The World Medical · What is medical ethics? Association, B.P. 63, 01212 Ferney-Voltaire Cedex, France; · Why study medical ethics? email: [email protected], fax (+33) 450 40 59 37. · Medical ethics, medical professionalism, human rights and of Contents Table Medical Ethics Manual – law This Manual is a publication of the World Medical Association. · Conclusion It was written by John R. Williams, Director of Ethics, ...14 WMA (2003-2006) Chapter One – Principal Features of Medical Ethics Medical Ethics Manual – Principal Features of · Objectives Cover, design and concept by Tuuli Sauren, · What’s special about medicine? INSPIRIT International Communications, Belgium. · What’s special about medical ethics? Production and concept by · Who decides what is ethical? World Health Communication Associates, UK. · Does medical ethics change? Pictures by Van Parys Media/CORBIS · Does medical ethics differ from one country to another? · The role of the WMA Cataloguing-in-Publication Data · How does the WMA decide what is ethical? Williams, John R. (John Reynold), 1942-. · How do individuals decide what is ethical? Medical ethics manual. · Conclusion 1. Bioethics 2. Physician-Patient Relations – ethics. 3. Physician’s Role 4. Biomedical Research – ethics Chapter Two – Physicians and Patients .................................34 5. Interprofessional Relations 6. Education, Medical – ethics · Objectives 7. Case reports 8. Manuals I. Title · Case study · What’s special about the physician-patient relationship? · Respect and equal treatment · Communication and consent ISBN 978-92-990079-0-7 · Decision-making for incompetent patients (NLM classification: W 50) · Confidentiality 2 3 · Beginning-of-life issues – Ethics review committee approval · End-of-life issues – Scientific merit · Back to the case study – Social value – Risks and benefits Chapter Three – Physicians and Society ...............................64 – Informed consent · Objectives – Confidentiality · Case study – Conflict of roles · – Honest reporting of results What’s special about the physician-society relationship? Medical Ethics Manual – Table of Contents Table Medical Ethics Manual – · Dual loyalty – Whistle blowing – Unresolved issues · Resource allocation · Back to the case study · Public health · Global health Chapter Six – Conclusion ............................................................... 116 Medical Ethics Manual – Principal Features of · Physicians and the environment · · Back to the case study Responsibilities and privileges of physicians · Responsibilities to oneself Chapter Four – Physicians and Colleagues ........................84 · The future of medical ethics · Objectives Appendix A – Glossary · Case study (includes words in italic print in the text) ....................................124 · Challenges to medical authority Appendix B – Medical Ethics Resources on the Internet ..........127 · Relationships with physician colleagues, teachers and students Appendix C – World Medical Association: Resolution on the Inclusion of Medical Ethics · Reporting unsafe or unethical practices and Human Rights in the Curriculum of · Relationships with other health professionals Medical Schools World-Wide, and · Cooperation World Federation for Medical Education: · Conflict resolution Global Standards for Quality Improvement – Basic Medical Education ..................................................................128 · Back to the case study Appendix D – Strengthening Ethics Teaching in Chapter Five – Medical Research ...............................................98 Medical Schools ..................................................................................130 · Objectives Appendix E – Additional Case Studies ............................................132 · Case study · Importance of medical research · Research in medical practice · Ethical requirements 4 5 ACKNOWLEDGMENTS FOREWORD Dr. Delon Human The WMA is profoundly grateful to the following individuals Secretary General for providing extensive and thoughtful comments on earlier World Medical Association drafts of this Manual: Prof. Solly Benatar, University of Cape Town, South Africa It is incredible to think that although the founders of medical ethics, Medical Ethics Manual – Foreword Prof. Kenneth Boyd, University of Edinburgh, Scotland such as Hippocrates, published their works more than 2000 years Dr. Annette J. Braunack-Mayer, University of Adelaide, Australia ago, the medical profession, up until now, has not had a basic, universally used, curriculum for the teaching of medical ethics. This Dr. Robert Carlson, University of Edinburgh, Scotland first WMA Ethics Manual aims to fill that void. What a privilege it is Mr. Sev Fluss, WMA and CIOMS, Geneva, Switzerland to introduce it to you! Medical Ethics Manual – Principal Features of Prof. Eugenijus Gefenas, University of Vilnius, Lithuania The Manual’s origin dates back to the 51st World Medical Assembly Dr. Delon Human, WMA, Ferney-Voltaire, France in 1999. Physicians gathered there, representing medical Dr. Girish Bobby Kapur, George Washington University, associations from around the world, decided “to strongly recommend Washington, DC, USA to Medical Schools worldwide that the teaching of Medical Ethics and Human Rights be included as an obligatory course in their Prof. Nuala Kenny, Dalhousie University, Halifax, Canada curricula.” In line with that decision, a process was started to Prof. Cheryl Cox Macpherson, St. George’s University, Grenada develop a basic teaching aid on medical ethics for all medical Ms. Mareike Moeller, Medizinische Hochschule Hannover, students and physicians that would be based on WMA policies, but Germany not be a policy document itself. This Manual, therefore, is the result of a comprehensive global developmental and consultative process, Prof. Ferenc Oberfrank, Hungarian Academy of Sciences, guided and coordinated by the WMA Ethics Unit. Budapest, Hungary Modern healthcare has given rise to extremely complex and Mr. Atif Rahman, Khyber Medical College, Peshawar, Pakistan multifaceted ethical dilemmas. All too often physicians are Mr. Mohamed Swailem, Banha Faculty of Medicine, Banha, unprepared to manage these competently. This publication is Egypt, and his ten fellow students who identified vocabulary that specifically structured to reinforce and strengthen the ethical was not familiar to individuals whose first language is other than mindset and practice of physicians and provide tools to find ethical English. solutions to these dilemmas. It is not a list of “rights and wrongs” but an attempt to sensitise the conscience of the physician, which The first edition of this Manual was supported in part by an is the basis for all sound and ethical decision-making. To this end, unrestricted educational grant from Johnson & Johnson. you will find several case studies in the book, which are intended to 6 7 foster individual ethical reflection as well as discussion within team settings. INTRODUCTION As physicians, we know what a privilege it is to be involved in the WHAT IS MEDICAL ETHICS? patient-physician relationship, a unique relationship which facilitates Consider the following medical cases, which could have taken place an exchange of scientific knowledge and care within a framework of in almost any country: ethics and trust. The Manual is structured to address issues related 1. Dr. P, an experienced and skilled surgeon, is about to finish to the different relationships in which physicians are involved, but at Medical Ethics Manual – Introduction night duty at a medium-sized community hospital. A young the core will always be the patient-physician relationship. In recent woman is brought to the hospital by her mother, who leaves times, this relationship has come under pressure due to resource immediately after telling the intake nurse that she has to look constraints and other factors, and this Manual shows the necessity after her other children. The patient is bleeding vaginally and of strengthening this bond through ethical practice. is in a great deal of pain. Dr. P examines her and decides that Finally, a word on the centrality of the patient in any discussion on she has had either a miscarriage or a self-induced abortion. He Medical Ethics Manual – Principal Features of medical ethics. Most medical associations acknowledge in their does a quick dilatation and curettage and tells the nurse to ask foundational policies that ethically, the best interests of the individual the patient whether she can afford to stay in the hospital until it patient should be the
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