WMA temporarily misplaces its conscience

The World Medical Association (WMA) is close to the end of a lengthy revision process of its International Code of Medical Ethics (ICoME). Originating in 1949 as a companion to its Declaration of Geneva, the ICoME has undergone various revisions. [1]

Concern arose in 2021 when the draft revision included the phrase: ‘Conscientious objection must only be considered if…undelayed continuity of care is ensured through effective and timely referral to another qualified physician.’ Such ‘effective referral’ requirements have caused considerable problems in jurisdictions such as Canada, where some physicians who object to involvement in euthanasia and refuse to refer to a willing colleague have been forced out of practice. [2]

CMF responded to the 2021 consultation, [3] as did numerous other ICMDA [4] member movements. A slightly improved draft went to a dedicated conference in Indonesia in July. There, experts and members of the WMA working group debated for and against various options. [5] Thankfully, a better draft has emerged. This was further honed at another WMA meeting in Washington, USA, in August 2022. [6] Excellent coordinated action by allies, including ICMDA member movements in the USA and Canada, as well as the Anscombe Bioethics Centre [7] – was instrumental in ensuring that this improved draft emerged.

The final step in the process will be a ratification meeting in Berlin in early October 2022. The current draft of the section reads:

‘This Code represents the physician’s ethical duties. However, on some issues there are profound moral dilemmas concerning which physicians and patients may hold deeply considered but conflicting conscientious beliefs…Physician conscientious objection to provision of any lawful medical interventions may only be exercised if the individual patient is not harmed or discriminated against and if the patient’s health is not endangered.

The physician must immediately and respectfully inform the patient of this objection and of the patient’s right to consult another qualified physician and provide sufficient information to enable the patient to initiate such a consultation in a timely manner.’

This represents a much more balanced approach. We should be encouraged to see how wide consultation by the WMA, and sustained engagement by partner organisations, has produced an improvement. It also reminds us that ‘the price of liberty is eternal vigilance’. [8]