Is the international regulation of medical complicity with torture largely window dressing? The case of Israel and the lessons of a 12-year medical ethical appeal

This is the account of an ongoing appeal initiated in 2009 by 725 doctors from 43 countries concerning medical complicity with torture in Israel. It has been underpinned by a voluminous and still accumulating evidence base from reputable international and regional human rights organisations, quoted below, and has spanned the terms of office of four World Medical Association (WMA) presidencies and two UN special rapporteurs on torture. This campaign has been a litmus test of whether international medical codes regarding doctors and torture actually matter, and are applied rigorously and even-handededly, particularly when compelling evidence incriminates a WMA member association. Our findings in the case of Israel suggest that this is not true, and that impunity largely operates. The WMA seems in partisan violation of its mandate to be the official international watchdog on the ethical behaviour of doctors. And as the IMA case demonstrates, by their inaction national medical associations or other regulatory bodies appear to function at base as buttresses and shields of the state.

Physician outreach during a pandemic: shared or collective responsibility?

In ‘Ethics of sharing medical knowledge with the community: is the physician responsible for medical outreach during a pandemic?’ Strous and Karni note that the revised physician’s pledge in the World Medical Association Declaration of Geneva obligates individual physicians to share medical knowledge, which they interpret to mean a requirement to share knowledge publicly and through outreach. In the context of the COVID-19 pandemic, Strous and Karni defend a form of medical paternalism insofar as the individual physician must reach out to communities who may not want, or know to seek out, medical advice, for reasons of public health and health equity. Strous and Karni offer a novel defence of why physicians ought to intervene even in insular communities, and they offer suggestions for how this could be done in culturally sensitive ways. Yet their view rests on an unfounded interpretation of the Geneva Declaration language. More problematically, their paper confuses shared and collective responsibility, misattributing the scope of individual physician obligations in potentially harmful ways. In response, this reply delineates between shared and collective responsibility, and suggests that to defend the obligation of medical outreach Strous and Karni propose, it is better conceptualised as a collective responsibility of the medical profession, rather than a shared responsibility of individual physicians. This interpretation rejects paternalism on the part of individual providers in favour of a more sensitive and collaborative practice of knowledge sharing between physicians and communities, and in the service of collective responsibility.

Types of remodeling and assessment of myocardial diastolic function in patients with ACS and CCS

Funding Acknowledgements Type of funding sources: None. Objective to study the features of the structural and functional condition of the myocardium in patients with various forms of coronary artery disease. Methods. 165 patients with various forms of coronary artery disease were examined. On average, patients NSTEMI - 90, NSTE-ACS - 25, STEMI - 25, chronic coronary syndrome (CCS) - 25. Features of structural and functional condition of the myocardium were determined by echocardiography in M-, B, and D-modes. All of research corresponding to the principles of the Declaration of Helsinki of the World Medical Association. Results. Evaluation of the nature of structural-geometric remodeling of the left ventricle (Fig. 1) revealed the predominance of normal geometry in patients with NSTEMI in comparison with STEMI (8 (8.9%) vs. 2 (8.0%), p= 0.06), and in the group with NSTE-ACS in comparison with STEMI (0 (0) vs. 2 (8.0%), p = 0.02). Concentric remodeling was significantly more common in the group of patients with NSTEMI compared with STEMI (23 (25.6%) vs. 2 (8.0%), p = 0.06), and in the group with NSTE-ACS compared with STEMI (9 ( 36.0%) vs. 2 (8.0%), p = 0.02). Analysis of the nature of diastolic transmitral blood flow revealed the following changes normal type - 5 vs. 0 in the groups of NSTE-ACS and STEMI, respectively (p = 0.02), the type of relaxation disorder - 58 against 19 in the groups NSTEMI and NSTE-ACS, respectively (p = 0.02), 58 vs. 13 in the NSTEMI and STEMI groups, respectively (p = 0.03), 19 vs. 13 in the NSTE-ACS and STEMI groups, respectively (p <0.0001), 19 vs. 16 in the NSTE-ACS and CCS groups, respectively (p= 0.04), by type of pseudonormalization - 23 against 1 in the groups NSTEMI and NSTE-ACS, respectively (p =0.02), 23 against 12 in the groups NSTEMI and STEMI, respectively (p = 0.03), 1 against 12 in the groups NSTE-ACS and STEMI, respectively (p <0.0001), 1 vs. 6 in the groups NSTE-ACS and CCS, respectively (p = 0.04). Conclusions. The highest degree of concentric remodeling was found in patients with NSTE-ACS, concentric hypertrophy in the CCS group, excentric hypertrophy in the STEMI group. Changes in transmitral blood flow by type of relaxation disorder prevailed in the NSTE-ACS group, by type of pseudonormalization in STEMI patients. In patients with NSTEMI, transmitral blood flow prevailed as a type of relaxation disorder. Abstract Figure. Fig. 1

Influence of plasma ST2 level on myocardial remodeling in NSTEMI

Funding Acknowledgements Type of funding sources: None. Objective to establish a relationship between types of myocardial remodeling and plasma ST2 levels in NSTEMI. Methods. 90 patients with NSTEMI were examined. Features of structural and functional condition of the myocardium were determined by echocardiography in M-, B, and D-modes. All of research corresponding to the principles of the Declaration of Helsinki of the World Medical Association. Results. It is established, that relatively low level (RL) corresponded to 24, the relatively moderate level (RM) to 44, and the relatively high (RH) level of ST2 to 24 individuals, respectively. For patients in the main group, these levels were < 26 and > 56 ng / ml, respectively. Instead, the relatively moderate (or intermediate) ST2 level (RM) for these patients was 26-56 ng / ml. It was determined that in patients with explosives in comparison with RH levels of ST2 in blood plasma there is a significant increase in the value of LA (42 mm vs. 38 mm, p-0.03), iLA (20.3 mm / m2 vs. 18.3 mm / m2, p-0.04), ESS (36 mm vs. 32 mm, p-0.008), EDS (52 mm vs. 49 mm, p-0.04), Ve / Va ratio (0.79 vs. 0.74, p-0.03), iLC (2.72 vs. 2.06, p = 0.03), iMMLV (121 g / m2 vs. 108 g / m2, p = 0.04), a decrease in the ratio of RV to EDS (0.49 vs. 0.54, p = 0.01) and the value of EF (56% vs. 61%, p = 0.03) (Tab. 1). The ratio of LA to RA was 1.13 against 1.06, p= 0.04. In addition, in patients with RH level compared with patients with RM level, there was a significant increase in the value of ESS (36 mm vs. 34 mm, p = 0.05). The ratio of Ve / Va was 0.79 vs. 0.66, p =0.01, iLC -2.72 vs. 2.43, p-0.0006. Conclusion. Elevated ST2 levels greater than 56 ng / ml in patients with NSTEMI were found to be associated with more severe structural left ventricular remodeling, left atrial overload, and decreased left ventricular contractility. The latter is manifested by a decrease in the value of PV and an increase in the value of Ve / Va, which changes in the direction of the formation of a restrictive type of diastolic transmitral blood flow. In turn, the ratio of RV to EDS shows the advantage of LV dilatation over RV. Tab. 1Echo indicatorsRL level ST2RM level ST2RH level ST2PLA, mm38 (35; 39)39 (37; 41)42 (37; 42)Р1-3 = 0,03EDS, mm49 (46; 52)50 (48; 53)52 (48; 54)Р1-3 = 0,04EF, %61 (59; 64)59 (53; 62)56 (58; 60)Р1-3 = 0,03Ve/Va0,64 (0,56; 0,78)0,66 (0,58; 0,74)0,79 (0,60; 1,20)Р1-3 = 0,03 Р2-3 = 0,01іММLV, g/m2108 (91; 117)115 (100; 127)121 (106; 130)Р1-3 = 0,04

Linking the Declarations of Helsinki and of Taipei: Critical Challenges of Future-Oriented Research Ethics

Expansion of data-driven research in the 21st century has posed challenges in the evolution of the international agreed framework of research ethics. The World Medical Association (WMA)’s Declaration of Helsinki (DoH) has provided ethical principles for medical research involving humans since 1964, with the last update in 2013. To complement the DoH, WMA issued the Declaration of Taipei (DoT) in 2016 to provide additional principles for health databases and biobanks. However, the ethical principles for secondary use of data or material obtained in research remain unclear. With such a perspective, the Working Group on Ethics (WGE) of the International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP) suggests a closer scientific linkage in the DoH to the (Declaration of Taipei) DoT focusing specifically on areas that will facilitate data-driven research, and to further strengthen the protection of research participants.

SUMMARY REPORT OF THE SYMPOSIUM ON PERSON CENTERED MEDICINE AT THE WORLD MEDICAL ASSOCIATION ETHICS CONFERENCE IN REYKJAVIK 2018

With medical care being increasingly driven by management systems founded on cost containment, cost efficiency, and cost efficacy, doctors are becoming burnt out especially in the United States within the complexities of an insurance-based system and in the United Kingdom by narrowly based directed government policies. Doctors are increasingly unable to fulfill their ethical obligations to their patients and are becoming “disconnected” from their work environment.

SUMMARY REPORT FROM THE 6TH INTERNATIONAL CONGRESS OF PERSON CENTERED MEDICINE

The idea that the Indian Medical Association (IMA) could host a congress on person-centered medicine (PCM) was presented at the 10th Geneva Conference on PCM in April 2017. The idea was well received and accepted by Prof. Ketan Desai, then President of the World Medical Association (WMA) and former President of the IMA. Soon thereafter preparations began as a collaborative effort of IMA and the International College of Person Centered Medicine (ICPCM). A contract was signed by representatives of IMA and ICPCM stipulating the framework and the financial issues of the congress.

MEDICAL PROFESSIONALISM AND ETHICAL AND HUMAN RIGHTS FOUNDATIONS OF PERSON-CENTERED MEDICINE

Person-centered medicine (PCM) is a concept that has gained increased acceptance, being a broader term than patient-centered medicine. With PCM the whole of a person is taken into consideration, whether healthy or in disease as well as his or her family. The person of the health professional is also incorporated in this concept. In this article, ethical background to person-centeredness in universal declarations and some international central policies are addressed. Primarily, the UN Universal Declaration on Human Rights (UDHR) will be discussed as well as official policy documents of the World Medical Association (WMA). Lastly, the content of a WMA Declaration on Medical Professionalism are discussed.

11th Geneva Conference on Person Centered Medicine: Summary Report

For the 11th time, the International College for Person-Centered Medicine (ICPCM) held its annual conference on Person-Centered Medicine in Geneva, Switzerland. As in previous years, the conference was supported by the World Health Organization, the World Medical Association, the World Organization of Family Doctors, the International Council of Nurses, the International Alliance of Patients’ Organizations and 30 other global health professional and academic institutions. The organizing committee was composed of the ICPCM Board members, with Ruth Wilson as program director. Material support was provided by the World Medical Association, the World Health Organization, the Geneva University Hospital, and the Paul Tournier Association.