Global physician ethics pledge gets biggest makeover in decades

Tanya Albert Henry , Contributing News Writer

Physician leaders have given the international modern-day Hippocratic Oath the most substantial update that it has seen in nearly 70 years, with revisions reflecting changes in the relationship between patients and physicians, and changes in interactions between physicians and their colleagues.

The World Medical Association (WMA) first adopted the Declaration of Geneva in 1948 as the contemporary successor to the 2,500-year-old Hippocratic Oath. Since then, just minimal amendments were made. But in October—after two years of gathering feedback from WMA member national medical associations, external experts and the public—the WMA adopted the revised Declaration of Geneva at its General Assembly meeting in Chicago.

In addition to the declaration’s being called “The Physician’s Pledge” for the first time, the policy:

  • References respecting the autonomy and dignity of the patient, which was not previously recognized in the declaration.
  • Adds that the “well-being” of a patient will be a physician’s first consideration, amending a clause to state that the “health and well-being of my patient will be my first consideration.”
  • Creates an obligation for respect between teachers, colleagues and students. Previously, it called for students to respect their teachers, but included no reciprocity.
  • Establishes an obligation for physicians to share medical knowledge for the benefit of their patients and the advancement of health care.
  • Requires physicians to attend to their own health, well-being and ability so they can provide the highest standard of care. This comes at a time when physicians have seen an increase in workload and a rise in occupational stress.
  • Augments an existing clause that calls for a physician to practice with conscience and dignity by having physicians pledge to practice with conscience and dignity “in accordance with good medical practice.” This was done to more explicitly invoke the standards of ethical and professional conduct that patients and physicians’ peers expect.

These changes “have enabled this pivotal document to more accurately reflect the challenges and needs of the modern medical profession,” German physician Ramin Walter Parsa-Parsi, MD, MPH, wrote in a JAMA Viewpoint essay about the revised policy. Dr. Parsa-Parsi is chair of the WMA’s Declaration of Geneva workgroup and a member of the WMA Medical Ethics Committee and WMA Council.

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WMA President Yoshitake Yokokura, MD, of Japan, noted that physicians’ lives today are completely different than they were in 1948.

The hope is that the revised Declaration of Geneva “will be used by all physicians around the world to strengthen the profession’s determination to maintain the highest standard of health care for patients,” he said.

The newly revised declaration is far from the only ethical guidance for physicians. The AMA has offered ethical guidance since the organization’s founding meeting in 1847, when the Association adopted the principles of the AMA Code of Medical Ethics. That living document guides physicians on meeting the ethical challenges of practicing medicine. The Code, among other things, says that physicians “shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights” and “shall support access to medical care for all people.”

Also it its General Assembly meeting, the WMA adopted policy on quality assurance in medical education, as well as bullying and harrassment in the medical profession, the role of physicians in preventing exploitive adoption practices, and more.

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