One of the central missions of the World Medical Association (WMA) in its role as the global organization of physicians is to ensure the highest possible standard of ethical practice of the medical profession. Since its establishment in 1947 in the aftermath of one of the most egregious breaches of medical ethical principles, the WMA has adopted a comprehensive range of declarations, resolutions, and statements aimed at providing ethical and other guidance to the global medical profession.
At the heart of the WMA’s body of policies are 3 core documents: the Declaration of Geneva: The Physician’s Pledge (DoG),1 the Declaration of Helsinki (DoH),2 and the International Code of Medical Ethics (ICoME).
The inaugural DoG, which was initially adopted by the second General Assembly of the WMA in 1948 and most recently revised in 2017, concisely lays out the basic ethical principles for the medical profession in the form of a physician’s pledge. Although the DoG has undergone regular revisions over the years, the basic principles have remained consistent.3
To address the specific ethical challenges of medical research involving human research participants, the WMA drafted and adopted the DoH in 1964. The DoH was last revised in 2013 and will undergo another revision starting in 2022. While geared primarily toward the medical profession, the DoH has proven to be a practical tool for nonphysician researchers as well.4
The third and perhaps least well-known—at least to this point—core document of the WMA is the ICoME, which was adopted in 1949 following the DoG. The ICoME outlines the ethical principles and professional duties of the medical profession, including the physician’s responsibilities toward patients and society, as well as toward other physicians, students, and other health professionals and personnel.
As with all of the WMA policies, these 3 documents are reviewed and revised regularly to ensure their continued relevance.
In 2018, the Council of the WMA installed an international workgroup to review the ICoME, which had last been revised in 2006. The workgroup comprised WMA constituent members and observers from 19 countries representing all the WMA’s geographic regions. (The WMA’s global membership is categorized according to the following 7 geographic regions: Africa, Asia, Europe, Latin America, North America, the Pacific, and Eastern Mediterranean.) Each member of the workgroup was encouraged to consult with local ethics committees and experts, and to review the existing ethical guidelines and professional codes in their respective countries and determine which ethical principles might be outdated or missing from the most recently revised ICoME.
The representative nature of the workgroup led to extensive discussions not only about the content of the revised ICoME, but also about the linguistic subtleties of the document and how certain concepts and terminology might be understood or interpreted differently from region to region. The workgroup invested great effort to ensure that the ICoME could be applicable to different cultures and political systems by carefully and transparently assessing proposals and comments from the different world regions.
