Declaration Of Geneva Research Articles

Medical oath: use and relevance of the Declaration of Geneva. A survey of member organizations of the World Medical Association (WMA).

The Declaration of Geneva is one of the core documents of medical ethics. A revision process was started by the World Medical Association (WMA) in 2016. The WMA has also used this occasion to examine how the Declaration of Geneva is used in countries throughout the world by conducting a survey of all WMA constituent members. The findings are highly important and raise urgent questions for the World Medical Association and its National Medical Associations (NMA): The Declaration of Geneva is only rarely used as an oath text despite the fact that physicians' oaths are generally widespread. This is not consistent with the intention and claim of the Declaration of Geneva. The article then discusses three questions. Should there be one single binding oath? Which organization should be responsible for such an oath? Which oath is the most obvious candidate? In a globalized world and despite all cultural diversity, the medical profession should have one core moral basis which is binding for physicians all over the world. The most obvious candidate for an oath incorporating this moral basis is the Declaration of Geneva.

Informed consent and medical ethics

Medical ethics has a very long history and it investigates ethical issues arising in medicine and health care provision by applying the principles of moral philosophy. The ancient ethical codes were often expressed in the form of oaths. The best known medical oath in the western tradition is the Oath of Hippocrates and often regarded as the very foundation of Western medical ethics. The Hippocratic School produced a large body of writings on medicine, science and ethics. In the ensuing centuries the principles of Christian humanism dominated the practice of medicine. Towards the end of 18th century the role of physicians in dealing with disease in individuals as well as population groups led to the drafting codes of professional conduct. Changing attitudes of society and the major advances in medical science at the beginning of the 20th centuries led to recognition of the need for modification of the Hippocratic Oath. This need was met by the Declaration of Geneva, formulated by the World Medical Association in 1947, supplemented by Declaration on particular aspects of medical ethics. Now, the advanced medical technologies or revolutionary developments in the biomedical sciences as well as in clinical medicine and its communication to the public has led to a growing need for the medical professional to be fully aware of society`s views on various developments. This, no doubt, enables ethical guidelines to reflect and safeguard the interests and wellbeing of patients.

SSH...DON’T TELL THE CHILDREN! NO DUTY TO WARN DESCENDANTS THAT THEY MAY HAVE INHERITED A SERIOUS MEDICAL CONDITION

In this edition of the Denning Law Journal we are celebrating the 800 years of the Magna Carta, but compared to some declarations the Magna Carta is a mere fledgling. Those with knowledge of the medical profession will be well versed in the Hippocratic Oath, which garnered a fundamental role in medical training during the Hellenic period. In more recent years, the Hippocratic Oath has been revitalised in the form of the Declaration of Geneva, and is still used as part of medical training today. Over time the Oath has been modified to adopt a more progressive stance, nevertheless in one key ethical principle remains untouched, that of confidentiality.

Eglantyne Jebb – A Pioneer of the Convention on the Rights of the Child

The efforts relating to the universal recognition of human rights of children are closely linked with the name of Eglantyne Jebb, who in 1924 convinced the governments assembled in the League of Nations to adopt a first document on children’s rights: “The Declaration of Geneva”. Children’s rights activists have often interpreted this declaration as a charity appeal and not a codification of rights. This article describes how Eglantyne Jebb’s thinking evolved about children and what mankind owes her. The dimensions of the work of the funds, which she founded and directed, the Save the Children Fund in Great Britain 1919 and the Save the Children International Union 1920, progressively showed her that charity is not enough and worldwide cooperation of governments is urgently required to establish structures and provisions to which children are entitled.

Integrating ethics in public health education: the process of developing case studies.

The study of ethics in public health became a societal imperative following the horrors of pre World War II eugenics, the Holocaust, and the Tuskegee Experiment (and more recent similar travesties). International responses led to: the Nuremberg Doctors’ Trials, the Universal Declaration of Human Rights (1948), and the Convention on Prevention and Punishment of the Crime of Genocide (CCPCG, 1948), which includes sanctions against incitement to genocide. The Declaration of Geneva (1948) set forth the physician’s dedication to the humanitarian goals of medicine, a declaration especially important in view of the medical crimes which had just been committed in Nazi Germany. This led to a modern revision of the Hippocratic Oath in the form of the Declaration of Helsinki (1964) for medical research ethical standards, which has been renewed periodically and adopted worldwide to ensure ethical research practices. Public health ethics differs from traditional biomedical ethics in many respects, specifically in its emphasis on societal considerations of prevention, equity, and population-level issues. Health care systems are increasingly faced with the need to integrate clinical medicine with public health and health policy. As health systems and public health evolve, the ethical issues in health care also bridge the gap between the separation of bioethics and public health ethics in the past. These complexities calls for the inclusion of ethics in public health education curricula and competencies across the many professions in public health, in the policy arena, as well as educational engagement with the public and the lay communities and other stakeholders.

WMA Declaration of Geneva

WMA Declaration of Geneva

Syria: What should health care professionals do?

Syria: What should health care professionals do?

Patient confidentiality: when can a breach be justified?

Confidentiality is central to the preservation of trust between doctors and their patients. The moral basis is consequentialist, in that it is to improve patient welfare. There is a wider communitarian public interest in the protection of confidences; thus, preservation of confidentiality is necessary to secure public health. Failure to maintain this venerable obligation may result in suboptimal treatment (X v Y [1992] 3 BMR 1). For centuries, doctors have upheld this ethical principle underpinned by the Hippocratic Oath that has been updated by the international community assenting to the Declaration of Geneva. The practice of doctors in the UK is subject to the regulatory authority of the General Medical Council (GMC) who strongly uphold this professional duty. The British Medical Association (BMA) advises doctors to consider the benefits of breaching patient confidentiality against the harmful consequences of damaging the professional relationship and risking public trust in a confidential service. However, medical confidentiality is not absolute in modern medicine. There are occasions when there is a need to breach this idealism. The legitimate exceptions are specified by the GMC’s professional code of conduct:

Trending in 2014: Hippocrates

Trending in 2014: Hippocrates

Imparting Surgical Training in Private Practice

Imparting Surgical Training in Private Practice

Hippocratic oath and conversion of ethico-regulatory aspects onto doctors as a physician, private individual and a clinical investigator.

Hippocratic Oath is a living document for ethical conduct of the physicians around the world. World Medical Association has been amending the oath as per the contemporary times. Although physicians maintain their ethical standards while treating a patient yet many a times social, administrative and ruling powers either use physicians as their tool of oppression or victimize them for conducting duties as per their oath. The Tuskegee Syphilis Study and Human Radiation Experiments in America, Nazi Experiments in Germany and compulsory sterilization program in India were the studies where States used physicians for the advancement of their rationality or belief. Conversely victimization of physicians in Kosovo, Sri Lanka and incarcerating physicians for treating human immunodeficiency virus/acquired immunodeficiency syndrome patients in some countries is concerning. The Nuremberg code, the Declaration of Geneva, Belmont Report and Declaration of Helsinki are ethical documents while active involvement of Food and Drug Administration through “common rule” resulted in guidelines like International Conference on Harmonization and Good Clinical Practices. Still unethical studies are found in developing countries. Studies such as experimental anticancer drugs in 24 cancer patients without adequate prior animal testing and informed consent in Kerala, studies at All India Institute of Medical Sciences in New Delhi resulted in 49 deaths of children and many more suspicious studies are rampant. Reverting back to the fundamentals of the medical profession; teaching medical ethics and enforcement of “medical neutrality” by embarking some grade of “medical immunity” on the basis of the oath is necessary for ethical conduct of physicians.

Laws Applicable to Medical Practice and Hospitals in India

ABSTRACT Healthcare in India features a universal healthcare care system run by the constituent states and territories. Law is an obligation on the part of society imposed by the competent authority, and noncompliance may lead to punishment in the form of monetary fine or imprisonment or both. The earliest known code of laws called the code of Hammurabi governed the various aspects of health practices including the fees payable to physician for satisfactory services. The first ever code of medical ethics called the Hippocratic oath was laid down 2500 years ago, in the 5th century BC, by Hippocrates'the Greek physician. The modern version of Hippocratic Oath (called the declaration of Geneva), devised by the WHO after the second world war and is accepted by international medical fraternity. The process of establishment of healthcare system during the colonial rule also necessitated creation of legislative framework for practitioners of medicine. As the number of doctors qualified in Indian medical colleges increased, creation of laws for them became necessary. The medical council of India, a national level statutory body for the doctors of modern medicine, was constituted after the enactment of Indian Medical Council Act 1933. The first legal recognition and registration for the Indian systems of medicine came when the Bombay Medical Practitioner’ Act was passed in 1938. Laws governing the commissioning of hospital are the laws to ensure that the hospital facilities are created after due process of registration, the facilities created are safe for the public using them, have at least the minimum essential infrastructure for the type and volume of workload anticipated and are subject to periodic inspections to ensure compliance. There are other laws pertaining to governing to the qualification/practice and conduct of professionals, sale, storage of drugs and safe medication, management of patients, environmental safety, employment and management of manpower, medicolegal aspects and laws pertaining to safety of patients, public and staff within the hospital premises. There are laws governing professional training and research, business aspects, licences/certifications required for hospitals, etc. A hospital administrator should be aware about all these laws, regulations, policies, procedures, reports and returns and keep abreast with the latest amendments to be on the safe side of law and provide quality care to the patients. How to cite this article Singh MM, Garg US, Arora P. Laws Applicable to Medical Practice and Hospitals in India. Int J Res Foundation Hosp Healthc Adm 2013;1(1):19-24.

Editorial

Editorial

Viewpoint: Interests, rights and standards of care in the context of globalized medicine

Viewpoint: Interests, rights and standards of care in the context of globalized medicine

A 15th Century “Bambino” is the Symbol of Global Maternal and Child Health

Having observed similar swaddled infants, often referred to as ‘‘Bambini’’ as the insignia of many Maternal and Child Organizations (Fig. 1), we were intrigued by what would have encouraged organizations from different countries to use this symbol. We seek to show that this choice was likely influenced by a large global movement. The insignia is derived from one of the fifteenth century terra cotta bas-reliefs from Andrea Della Robbia [1, 2]. The ten ‘‘Bambini’’ can still be seen on the facade of the ‘‘Ospedale degli Innocenti’’ in Florence, Italy (Fig. 2 for a set of two). The first of its kind, this Foundling Hospital of the Renaissance symbolizes the beginning of a humanistic movement to protect infants and children [1]. Movements advocating for child protection emerged in the XIX century, and were reinforced by the needs created by World War I [3]. Major child health organizations were founded in the immediate aftermath. The Save the Children International Union (SCIU) (Union Internationale de Secours aux Enfants), a Geneva-based organization, was founded in 1920 at the initiative of the Save the Children Fund (SCF) and the Swiss Committee for Children Relief (Comite Suisse de Secours aux Enfants) to implement child protection allover the world [4]. Eglantyne Jebb (1876–1928) and her sister Dorothy Buxton (1881–1962) played a central role in founding the SCF in England in May 1919 [5] and the SCIU. One of the main achievements of the SCIU was precisely the adoption of the Declaration of the Rights of the Child, or the ‘‘Declaration of Geneva,’’ which was approved by the Fifth Assembly of the League of Nations in 1924 and is the precursor to the United Nations Convention on the Rights of the Child adopted on November 20, 1989 [5, 6]. Between 1923 and 1933, the SCIU had members from 33 countries and nine affiliated organizations [7, 8]. In the United States (US), Save the Children was created in 1932 as the ‘‘International Save the Children Fund of America’’ and became a member of the SCIU [9]. The name of the US organization was changed to the ‘‘Save the Children Federation’’ in 1939 [9] and is now known as ‘‘Save the Children USA.’’[10] One of Della Robbia’s ‘‘Bambini’’ was chosen as the insignia by SCIU and the majority of its members and associate member organizations (Fig. 1) [7, 8]. It appeared on the 1924 Declaration of Geneva (Fig. 3) [11]. Other ‘‘Bambini’’ were chosen at the same period. It was the case of the Save the Children Federation and it is probably the inspiration for the current logo of Save the Children (personal communication, Save the Children, 2005). In Belgium, the National Children’s Relief Organization (Oeuvre Nationale de l’Enfance, Nationaal Werk voor Kinderwelzijn) used a ‘‘Bambino’’ since 1924, but became member of the SCIU only in 1942 [12]. The American Academy of Pediatrics (AAP) adopted a ‘‘Bambino’’ as insignia around 1930, modified it in 1941, and made it official in 1955 [2]. Several Latin American pediatric societies have followed AAP in adopting the ‘‘Bambino.’’ For example, the Brazilian Pediatric Society started using a ‘‘Bambino’’ in 1936 [13]. The ‘‘Bambini’’ vary by their degree of swaddling. Swaddling is described in the Bible and was widely used in Europe, Asia, and South America [14, 15]. Among the 10 original ‘‘Bambini’’ of the ‘‘Ospedale degli Innocenti’’, P. Buekens (&) School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Ste. 2430, New Orleans, LA 70112, USA e-mail: pbuekens@tulane.edu

Medicine, human rights and ethics: paths to universal rights

The core of global practical ethics consists in the international adherence to human rights. The medical and healthcare communities stand at the forefront of fundamental challenges. In 2008 the 60th anniversaries of the ‘‘Universal Declaration of Human Rights’’ and the ‘‘Declaration of Geneva’’ adopted by the World Medical Association were celebrated. In September 1948, the Second General Assembly of the World Medical Association adopted in Geneva a declaration on the ethics of the medical profession as an up-to-date ‘‘revision of the Hippocratic Oath.’’ The Declaration of Geneva thus became one of the most important sources for medical ethics, and an integral part of the professional code for medical personnel. Only weeks later—on December 10th 1948—the ‘‘Universal Declaration of Human Rights’’ was promulgated by the General Assembly of the United Nations in the Parisian Palais de Chaillot as the foundation for international humanitarian law. Article 11 postulated: ‘‘All human beings are born free and equal in dignity and rights.’’ The historical proximity of the two declarations was no accident; both were clearly reactions to the violations of human rights and human dignity under the National Socialist regime from 1933 to 1945. Ever since, the ‘‘Universal Declaration of Human Rights’’ has been the basis for international humanitarian law and served to give lasting protection to the individual. Health is an essential requirement for the UNO’s aims of

Medical Confidentiality: What Does it Mean to the Vulnerable?

Medical science has witnessed great advances that have resulted in better effective patient care and overall clinical outcome. This is largely due to medical technologies, research-oriented environment, multidisciplinary management, emphasis on enlightened state of care and ever increasing need for patients' full disclosure. The innovation and the improvement in patients' care come at a price-increase in volume of information; this needs processing . Paradoxically there is an increased requirement both in ethics and law for the preservation of this confidential information. The various theories underpinning ethics - Kantian , Consequentialism , Virtue ethics and Communitarianism uphold the need to maintain confidentiality to a different varying degree. Fidelity to the absolute need to preserve confidentiality is advocated by Kantian. This level of adherence is largely consistent with the Hippocratic Oath ; although ancient, the Oath continues to provide an overarching umbrella on national and international codes of practice. The Oath contains succinct but strong statement as regards confidentiality. Hippocratic medicine was a one-one consultation without the involvement of other professionals; health insurance and electronic transmission of information. Information disclosure for the overall benefit of the society was almost unknown. The Declaration of Geneva acknowledges the need to accord confidentiality an important recognition. Ethics and laws regarding confidentiality evolved long before the information age; the quality and nature of information held on patients are not only relevant to an integrated delivery of effective care, but have wider ramifications on public health, medical research/audit/education, public interests, and prevention of abuse and safeguards of the vulnerable.

Etičke norme za zdravstvene radnike

The concept of ethics goes back to the time of Hippocrates, the Greek physician from the IV century BC. The basic principle of Hippocrates was: Primum non nocere (First, not to harm). That principle has become the foundation of high ethics, which manifested itself in Hippocrates's relation towards his patients. The interest and welfare of patients is the primary and main goal of medical practice. Health care professionals most often take the updated version of The Hippocratic Oath - the Declaration of Geneva. The Declaration emphasizes the importance of the obligation to provide professional health assistance, regardless of religious affiliation, race, social standing and political beliefs. Professional knowledge must not be used contrary to basic laws of humanity. Besides the doctor-patient relationship, the doctor-doctor relationship is also very important .There are certain countries and associations where the term 'ethical' is identified with the term 'collegial'. Element for criticism that defines the doctor-doctor relationship, is the competition that exists among the doctors of medicine engaged in private practice. Competition can be considered as a natural state or social interaction, which is a result of the inevitable coexistence of equal interest, and a justified battle to take a better place in the hierarchy. However, the spread of intolerance, baseless accusations and other things that may damage the reputation and moral integrity of health professionals are not allowed. This does not refer to the right of each health professional to publicly present his/ her critical opinion, as long as it is done in the spirit of tolerance, and is in the best interest of science or the profession. One of the special aspects of medical ethics is the doctor-patient relationship. There are several current issues that remain open, concerning this relationship: medical fault and the causes of unfavorable outcomes of the treatment, the duty of doctors to inform patients about the diagnosis, outcome after the treatment, therapy and the risks that go with it (so the patient can decide whether to accept the therapy), the responsibility for the damage caused by medical appliances and injections. Doctor-patient relationship, that once used to be full of respect, is replaced by fear and distrust, and patients are encouraged to seek the help from the lawyers. Nowadays, there are two concepts in medical practice: the defensive medicine and evidence-based medicine. The defensive medicine always takes into account the possibility of a judicial process and sometimes applies unnecessary diagnostic and therapeutic procedures. Evidence-based medicine justifies its actions by existence of valid scientific evidences. What is the solution? Kind behavior towards the patient, but firm attitude based on knowledge and determination, is the way one should follow in order to improve modern medicine, or in other words, Lege Artis, at any cost.

Quality of life and ethical and legal dilemmas in children during and after hematopoietic SCT procedure

There is not any doubt that the SCT procedure involves important ethical and legal aspects. The expectations of patients concerning the quality of life and the new way of treatment are certainly an important motivation for researchers and physicians. Societies in Europe seem to accept the idea of using their own or allogeneic stem cells for tissue engineering and transplantation. A physician should be aware of the standards established by tradition and act within the general principles that have governed professional conduct. The International Code of Ethics and the Declaration of Geneva (1948), developed and approved by the World Medical Association, have modernized the ancient codes. They have been endorsed by each member organization, including The Polish Medical Association, as a general guide with nationwide application. The Polish Chamber of Physicians accepts the responsibility of delineating the standard of ethical behavior expected of Polish physicians. An interpretation of the principles concerning SCT is developed in the following pages as a guide for individual SCT physicians.

The Declaration of Helsinki and public health

The Declaration of Helsinki and public health