After an intensive 4-year process, the World Medical Association (WMA) has revised its International Code of Medical Ethics (ICoME). In their report outlining this process, Parsa-Parsi et al not only describe how the WMA sought to ‘cultivat[e] international agreement’ on a ‘global medical ethos’, but also outline the philosophical framework of the ICoME: how the WMA, as the ‘global representation of the medical profession’, created and revised the ICoME through the process of international professional self-regulation.1 However, there is a significant (...) tension to be found in this framework—one which contrasts the international scope of the ICoME with the supposed source of its legitimacy. Here, we seek to characterise this tension and the doubt which it casts on the legitimacy of the ICoME. (shrink)

Parsa-Parsi _et al_ systematically discuss and elucidate contentious and non-controversial ethical issues that emerged during the ICoME (International Code of Medical Ethics) revision process and the consensus they achieved. The ethical issues discussed include the physician’s duty to act in the best interests of patients and to ensure they are protected from the unjustifiable risk of harm, respect for patient autonomy and the duties of physicians during emergencies, among others. This paper examines paragraph 26, which requires doctors to provide only (...) medically justified remote treatment, ensure patients offer informed consent and adequately protect their confidentiality. 1 At the peak of the COVID-19 pandemic, many countries in Europe and America implemented remote-by-default healthcare policies. At that time, the policy aimed to ensure that patients enjoyed continued access to care while protecting healthcare professionals’ health and well-being. After the COVID-19 pandemic, this policy remained in place. Regardless of the nature... (shrink)

У статті визначено основні загрози збереження культурної спадщини країн, що виникають при переміщенні їх культурних цінностей через митний кордон. Обґрунтовано, що для України такими загрозами є: а) відсутність нормативно-правових актів, які б регулювали питання проведення митного контролю за ввезенням культурних цінностей в Україну; б) відсутність системи розрізнення культурних цінностей та предметів культурного призначення; в) неврегульованість у законодавстві принципів ідентифікації культурних цінностей; г) відсутність спеціалізованого органу, який вирішує питання можливості переміщення культурних цінностей через митний кордон країни; д) невідповідність національного свідоцтва на (...) право вивезення культурних цінностей міжнародним стандартам та встановленим відповідним документам; е) відсутність електронного реєстру виданих свідоцтв на право вивезення культурних цінностей з України; є) слабкість та неефективність організації митного та іншого видів контролю за ввезенням культурних цінностей, що сприяє розвитку нелегального ринку культурних цінностей та використання України як транзитної території. Проаналізовано заходи Інтерполу, ЮНЕСКО та Міжнародної ради музеїв щодо боротьби із незаконним обігом культурних цінностей. Здійснено оцінку існуючого порядку переміщення культурних цінностей через митний кордон України та обґрунтовано ймовірні ризики. (shrink)

The World Medical Association (WMA), the global representation of the medical profession, first adopted the International Code of Medical Ethics (ICoME) in 1949 to outline the professional duties of physicians to patients, other physicians and health professionals, themselves and society as a whole. The ICoME recently underwent a major 4-year revision process, culminating in its unanimous adoption by the WMA General Assembly in October 2022 in Berlin. This article describes and discusses the ICoME, its revision process, the controversial and uncontroversial (...) issues, and the broad consensus achieved among WMA constituent members, representing over 10 million physicians worldwide. The authors analyse the ICoME, including its response to contemporary changes and challenges like ethical plurality and globalisation, in light of ethical theories and approaches, reaching the conclusion that the document is a good example of international ethical professional self-regulation. (shrink)

Parsa-Parsi _et al_ assert that the International Code of Medical Ethics (ICoME) provides a professional standard that overrides conflicting national legal norms. 1 While this claim is made in the context of laws that require doctors to participate in ‘acts of torture, or other cruel, inhuman, or degrading practices and punishments’ (para10 of ICoME), the underlying premise that medical ethics supersedes law requires scrutiny. It is clear that medical ethics and law are linked inextricably, but there is unresolved debate about (...) the sequence of this interaction: should ethics shape law; or is it the converse? Important principles, notably respect for patients’ autonomy, have arisen from case law and subsequently been adopted into medical ethics. As pointed out by Beauchamp and Childress, it is only ‘since the mid-1970s (that) the primary justification advanced for requirements of informed consent has been to protect autonomous choice’ (pg.118). 2 Whereas, the... (shrink)

Paragraph 12 of the revised International Code of Medical Ethics (ICoME) states that ‘the physician should strive to practise medicine in ways that are environmentally sustainable with a view to minimising environmental health risks to current and future generations.’ 1 This emphasis on environmental sustainability is in line with popular discourse as well growing scholarly attention in medical ethics for healthcare’s contribution to climate change. Recent research analyses, for instance, the ‘greening’ of informed consent and related bioethical principles. 2 3 (...) It is unclear what the duty of practising sustainable healthcare means at the level of doctor–patient interaction. Parsa-Parsi _et al_ flag the potential conflict in the ICoME’s provisions if ‘the actions of physicians are influenced by environmental considerations to the detriment of patients’ (p. 2), noting that the ICoME does not provide a handhold to improve understanding of such tensions. The code ‘does not... (shrink)

Parsa-Parsi _et al_ bring attention to the World Medical Association (WMA) and transparency to its International Code of Medical Ethics (ICoME) revisions. 1 We value their report and the revised ICoME but explain here that the ICoME cannot reflect consensus among all WMA members, or the wider medical profession, given structural and epistemic injustices that restrain low-income and middle-income country (LMIC) physicians from participating in activities such as WMA revisions. Such injustices overlook experiences and contributions of those from LMICs and (...) marginalised groups, hindering their access to and influence within medicine. 2 They also undermine access to information about, and from, the WMA. Recruiting new members from, and better engaging members in, LMICs would strengthen the WMA and its influence across the medical profession, and better elevate environmental sustainability as a biomedical and bioethical concern. This would be beneficial because there is controversy among physicians, bioethicists and... (shrink)

ENTREVISTA COM PROFISSIONAIS DA FILOSOFIA QUE ATUAM EM PROJETOS – BLOCO ICom: Lucas Dilacerda, Paulo Jorge Leandro, Paulo W. Lima, Raquel R. RochaPor: Antônio Alex Pereira de Sousa, Paulo Willame Araújo de Lima.

ENTREVISTA COM PROFESSORAS (ES) DE FILOSOFIA DO ENSINO SUPERIOR DO CEARÁ – BLOCO ICom: Ada Beatriz Gallicchio Kroef, Vicente Thiago Freire Brazil, Roberta Liana Damasceno Costa, Elizabeth Bezerra FurtadoPor: Antônio Alex Pereira de Sousa, Paulo Willame Araújo de Lima.

ENTREVISTA COM PROFESSORAS(ES) DE FILOSOFIA DO ENSINO MÉDIO DO CEARÁ – BLOCO ICom: Debora Klippel Fofano, Francisca Evanice Mourão Lima, John Karley de Sousa AquinoPor: Antônio Alex Pereira de Sousa, Paulo Willame Araújo de Lima.

We thank our commentators for their thoughtful responses to our paper 1 covering among other issues the relationships of ethics law and professional codes, the tensions between ethical universalism and cultural relativism and the phenomenon of moral judgement required when ethical norms conflict, including the norms of patient care versus obligations to others both now and in the future. Although the comments deserve more extensive discussion, in what follows we respond briefly to specific aspects of each commentary and remind readers (...) that professional codes of ethics are necessarily brief and that the International Code of Medical Ethics (ICoME) explicitly refers to the World Medical Association’s (WMA) mutually concordant and far more extensive ‘body of policies’. 2 Should ethics shape law or vice versa? Sarela raises a fundamental and, as stated in the commentary, unresolved debate: ‘should ethics shape law or is it the converse’? 3... (shrink)