Can representatives of more than 10 million physicians worldwide agree on a foundation of medical ethical principles?

By Ramin W Parsa-Parsi, Raanan Gillon, Urban Wiesing.

In today’s polarised world, achieving unanimous support for anything is a rare occurrence – let alone anything ethical. Simply agreeing to disagree to avoid outright confrontation is already a high enough bar to clear. It is in this climate that the World Medical Association (WMA) faced the monumental task of revising and modernising its International Code of Medical Ethics (ICoME), which was adopted unanimously in its revised form in October 2022 by the WMA’s General Assembly in Berlin, Germany.

Originally adopted in 1949, the ICoME is not as well-known as its high-profile siblings, the Declaration of Helsinki or the Declaration of Geneva: The Physician’s Pledge, but we would argue that its relevance as a foundation of medical ethical principles remains indisputable. However, social changes since its last revision in 2006 – especially ever increasing ethical pluralism within countries and the ever increasing globalisation of medicine and health care provision meant that the ICoME did require an overhaul.

The road to revision was long and not without hurdles. Representatives of medical organisations from nearly all continents held regular meetings to dissect and examine intricate ethical questions, informed by a broad range of cultural, religious, and political perspectives and experiences. One of the greatest challenges facing the workgroup – namely, how to develop a common ethical language amidst a diversity of perspectives and backgrounds – ultimately translated into a much stronger and more representative document.

The broad consensus achieved by the WMA under these circumstances – manifested by the unanimous adoption of the revised ICoME by its General Assembly, representing more than 10 million physicians worldwide – could potentially raise some eyebrows. At a time when ideological polarisation seems to know no bounds, one could ask whether the unanimous support for this document reflects a lack of depth or an evasion of the most controversial ethical questions – just another example of agreeing to disagree, an ethical lowest common denominator, so to speak. To this we emphatically respond that we believe the WMA has succeeded in providing a really useful framework of the global medical profession’s core moral commitments. Ethically speaking, the ICoME represents a remarkably high ‘common denominator’.

While the ICoME intentionally avoids detailed definitions or examples, it does not shy away from controversial topics like participation or oversight of cruel, inhuman, or degrading practice and punishments, physician conscientious objection, potential justifications for breaching patient confidentiality, the duties of physicians in emergency situations, decision making for those who can’t make their own medical decisions, and the permissibility of advertising and marketing by physicians. The consensus achieved on these and other issues indicates a clear understanding, despite linguistic, cultural and other differences, of the foundation of medical ethics – that is, establishing and maintaining patients’ trust in the medical profession, wherever and whenever they seek care.

The WMA was founded in response to the deplorable violations of medical ethics and professionalism carried out by physicians during WWII. Given this historical context and the organisation’s commitment to respond to new changes and challenges, it is our opinion that the WMA has a strong mandate to provide such a pivotal document for the world’s physicians as a model of global ethical and professional self-regulation.

In our article, The Revised International Code of Medical Ethics: an exercise in international professional ethical self-regulation, we highlight both the controversial and uncontroversial amendments made to the revised ICoME, along with the ethical theories and approaches that informed and influenced us throughout this 4-year revision process.  But we look forward to reading feedback and suggestions for its next revision, whenever that may be.

 

Paper title: The Revised International Code of Medical Ethics: an exercise in international professional ethical self-regulation

Authors:  Ramin W Parsa-Parsi, Raanan Gillon, Urban Wiesing

Affiliations:

RWP-P: Department for International Affairs, German Medical Association, Berlin, Germany

RG: Department of Primary Care and Public Health, Imperial College London, London, UK

UW: Institut für Ethik und Geschichte der Medizin, University of Tübingen, Tübingen, Germany

Competing interests:

RWP- P served as a council member of the World Medical Association (WMA), as a member of the WMA Medical Ethics Committee and as chair of the International Code of Medical Ethics (ICoME) revision workgroup.

RG served as a member of the ICoME revision workgroup and UW serves as WMA ethics advisor and served as a member of the ICoME revision workgroup.

All three authors received financial support for travel and accommodation for WMA ICoME

related conferences or meetings. UW received grants or payments for lectures and presentations from the industry or organisations for other not directly related projects. RG is the Honorary President of the Insitute of Medical Ethics and an elected member of British Medical Association (BMA) Council.

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