- Ramin W Parsa-Parsi, head1,
- Raanan Gillon, emeritus professor of medical ethics2,
- Urban Wiesing, director3
Increasing global mobility, and the growing plurality in society that comes with it, has an undeniable effect on medical practice. The likelihood of patients consulting doctors with different cultural backgrounds, religions, or secular values has increased substantially. This raises several essential questions for the medical profession around whether patients can expect a core set of ethical norms from all doctors regardless of their location, backgrounds, and beliefs or whether patients have to accept that ethical norms will differ depending on where they are in the world. We firmly believe that the medical profession across the world needs common answers to such questions and that there should be (and is) a core set of ethical norms for the world’s doctors.
The World Medical Association (WMA) was founded after the second world war largely to re-establish trust in the medical profession by re-affirming that there were some norms of medical practice that must apply to all doctors globally. The WMA Declaration of Geneva1—also known as the physician’s pledge and regarded as a modernised version of the Hippocratic oath—was adopted in 1948 and intended to prevent the horrific ethical failures of doctors during the war from being repeated. A year later, practical implications of that declaration for medical practice were agreed in the first International Code of Medical Ethics.2 Then in 1964 the first code of ethics for medical research was published as the Declaration of Helsinki.3
To re-establish trust in doctors and medicine, the medical organisations represented by the WMA clearly thought that their members, now more than 10 million doctors, were required to adhere to common norms of medical ethics no matter where they practised. But could that commitment survive the ever increasing challenges of globalisation? Yes; over a four year process, ending in October 2022, the WMA revised the International Code of Medical Ethics, with its own intrinsic international and intercultural input, augmented by a variety of international conferences at which drafts of the revised document were reviewed, and we have described this revision process in the Journal of Medical Ethics.4 As the WMA regularly updates all its policies, and a substantive revision of the Declaration of Geneva had been concluded in 2017, it became even more important for the International Code of Medical Ethics to be reviewed and modernised.
The revised code provides a framework of ethical principles and values to which patients globally can expect doctors to adhere. The updated guidelines reflect consensus on certain globally acceptable and trust enhancing underlying ethical drivers and on important specific obligations that flow from these. The many “shoulds and musts” for doctors to adhere to in the revised code are underpinned by the four fundamental ethical principles of beneficence, non-maleficence, respect for autonomy, and justice/fairness, augmented by the two additional core ethical principles of respect for human life and respect for human dignity.45
We acknowledge that the revision process would have benefited from even broader international participation, particularly from resource limited settings.6 Nevertheless, it is reassuring that the international WMA workgroup tasked with leading the revision process agreed easily and rapidly on most parts of the code. After an extensive in-person and online international consultation process, the WMA General Assembly adopted the final version of the revised code unanimously.4
When the international workgroup encountered conflict and tension on certain topics, most notably that of conscientious objection by doctors, it sought a balance between stating specific, detailed duties and providing more general accounts of duties that leave room for professional judgment and interpretation.
Potential conflicts between doctors’ duties and patient rights were considered in debates about the conscientious objection paragraph of the code, not only in the workgroup, but also in the WMA’s broader Medical Ethics Committee, in an online and worldwide public consultation, and in a conference dedicated to the subject of conscientious objection, where proponents of a broad spectrum of viewpoints were invited to speak and debate. Some of the most contentious moral issues that doctors encounter in their medical practice are not specifically included in the International Code of Medical Ethics—notably abortion and physician assisted suicide. However, the code focuses on laying down the basic ethical principles for doctors. Despite the existence of universal ethical principles, some genuine moral dilemmas arise, about which there will be deeply conflicting moral views, and a relatively short code of ethics cannot resolve them.6
By adhering to these updated principles, the global medical community will reassure patients and populations and strengthen its own trustworthiness and professional standing. We advocate for the International Code of Medical Ethics to become standard reading for all medical students and doctors. One way to increase awareness of the code would be to include it in the curriculum of basic medical education.
With this comprehensive revision, the WMA once again shows that the physicians of the world are united by one global medical ethos.
The authors are grateful to Siobhan O’Leary for her assistance.
Competing interests: RWP-P has been a council member of the World Medical Association (WMA), a member of the WMA Medical Ethics Committee, and chair of the International Code of Medical Ethics revision workgroup. In this capacity, he received financial support for travel and accommodation for WMA International Code of Medical Ethics related conferences or meetings. RG was a member of the International Code of Medical Ethics revision workgroup. He is honorary president of the Institute of Medical Ethics and an elected member of BMA Council. UW is WMA ethics adviser and was a member of the International Code of Medical Ethics revision workgroup. In this capacity, he received financial support for travel and accommodation for WMA International Code of Medical Ethics related conferences or meetings. He also received grants or payments for lectures and presentations from the industry or organisations for other not directly related projects.
Provenance and peer review: Not commissioned; not externally peer reviewed.