Revised WMA Declaration of Delhi on Health and Climate Change: For comments

Health Care, Medicine Comments Off

Document no: SMAC 206/Climate Change REV2/Apr2017 Original:
English
Title: Revised WMA Declaration of Delhi on Health and Climate Change ¬
Destination: Constituent Members Action(s) required:
For Comments
Note: The Associate Members submitted this proposed statement to the General Assembly in Taipei (October 2016), under the initiative of the Junior Doctors Network (JDN). The General Assembly passed it to the 204th Council Session, which decided to circulate it to the members for comments. The Council in Livingstone (April 2017) considered the compromise version based on the comments received and decided to return the draft to the rapporteur for further work in view of the discussion during the meeting, before a new circulation.
Suggested Keywords: Climate change, air pollution, environment, Paris Agreement, Marrakesh Agreement, COP, mitigation, heat waves, flooding

¬
REAMBLE
1.      Compelling evidence substantiates the numerous health risks posed by climate change, which threaten populations of low, middle and high-income countries. These include more frequent and potentially more severe heat waves, droughts, flooding and other extreme weather events including storms and bushfires. The resulting climate change, especially warming, is already leading to changes in the areas in which disease vectors flourish. There is reduced availability and quality of potable water, and worsening food insecurity leading to malnutrition and population displacement. Global warming is universal but its effects are unevenly spread and many of the areas most strongly affected are least able to manage the challenges it poses.

2.      Tackling climate change offers opportunities to improve health and wellbeing both because of the health co-benefits of low carbon solutions and because mitigation and adaptation allow action on all the social determinants of health.  Transition to renewable energy, the use of active transport, dietary change including a reduction in consumption of red meat, may all contribute to improving health.  Mitigation actions, such as those on reducing indoor and outdoor air pollution, will reduce health harms suffered predominantly by poorer people.
¬
3.      The social determinants of health are those factors that adversely affect health through exposure before and after people are born and as they grow live, and work.  They are worse in the poorest populations of all countries and also vary between countries.  Those with generally the poorest health and lowest life and health expectancy will be least able to adapt to deal with global warming exacerbating adverse social determinants of health.  Assisting these countries is a common but differentiated responsibility.
¬
4.      Climate change research and surveillance is important and the WMA supports studies seeking to describe the patterns of disease that are attributed to climate change, including the impacts of climate change on communities and households; to quantify and model the burden of disease that will be caused by global climate change including emergent diseases; to describe the most vulnerable populations.
¬
5.      The Paris Agreement highlights a transition to a new model of global collaboration to address Climate Change and represents an opportunity for the health sector to contribute to climate action.  It includes a series of actions to be undertaken in each nation to attempt to limit the global increase in average temperature to less than 1.5 C.
¬
RECOMMENDATIONS
¬
6.    The World Medical Association and its Constituent Members:
¬
6.1     Urge national governments urgently to recognize the serious health consequences of climate change and to adopt strategies to adapt to and mitigate the effects of climate change;
¬
6.2        Urge national governments to work to ensure fulfillment of national commitments to the Paris Agreement, including both mitigation and adaptation measures as well as action on losses and;
¬
6.3     Urges national government to ensure that climate financing must include designated funds to support the strengthening of health systems, and health and climate co-benefit policies and through this, to ensure the availability of sufficient global, regional and local financing for climate mitigation, adaptation measures, disaster risk reduction, and the attainment of the Sustainable Development Goals (SDGs);
¬
6.4        Urge national governments to engage with health sector representatives in developing and implementing climate change plans and emergency planning and response on local, national and international levels;
¬
6.5        Urge national governments to provide for the health and wellbeing needs of people displaced by environmental causes both within their countries and others including those becoming refugees due to the consequences of environmental changes.
¬
7.      National Medical Associations and their physician members should:
¬
7.1        Advocate for sustainable, environmentally responsible low-carbon practices across the health sector to reduce the environmental impact of health care facilities and practices.
¬
7.2        Prepare for the infrastructure disruptions that accompany major emergencies, in particular by planning in advance for the delivery of services during times of such disruptions and increased patient care demands;
¬
7.3        Encourage and support advocacy for environmental protection and greenhouse gas emissions reductions including through emissions trading systems and/or carbon taxes.
¬
8.      The WMA and its Constituent Members should:
¬
8.1        Encourage sustainable low-carbon living including active lifestyle, low-carbon agricultural and food production processes and diet, and sustainable production and consumption patterns;
¬
8.2        Seek to build professional and public awareness of the importance of the environment and global climate change to personal, community and societal health;
¬
8.3        Work towards the integration of key climate change concepts and competencies in undergraduate, graduate and continuing medical education curricula;
¬
8.4        Collaborate with WHO and other organizations as appropriate, to produce educational and advocacy materials on climate change for national medical associations, physicians, other health professionals, as well as the general public;
¬
8.5        Work towards increasing resilience including by preparing physicians, physicians’ offices, clinics, hospitals and other health care facilities for the infrastructure disruptions that accompany major emergencies, in particular by planning in advance the delivery of services during times of such disruptions;
¬
8.6        Seek to ensure that physicians are involved in the planning and delivery of primary ill-health prevention strategies in relation to climate change, working with NGOs, IGOs and governments;
¬
8.7        Advocate for their respective governments adequately funded climate change research and collaborate with governments, NGOs and other health professionals to develop knowledge about the best ways to address health impacts of climate change;
¬
8.8        Work collaboratively with government and NGOs to develop systems for event alerts in order to ensure that health care systems and physicians are aware of climate-related events as they unfold, and receive timely accurate information regarding the management of emerging health events.
¬
9.      The WMA urges National Medical Associations to:
¬
9.1        Work with health-care institutions, and individual physicians to adopt climate policies and act as role models by striving to reduce their carbon emissions, for instance by adopting more sustainable travel policies and increasing the use of on-line meetings.
¬
9.2        Recognize environmental factors as a key element inherent within the social determinants of health (SDH) agenda, and encourage governments to foster collaboration between the Health and non-health sectors in addressing these determinants.

Dr KK Aggarwal
National President IMA & HCFI

Proposed Revision of the World Medical Association Declaration of Geneva: For comments and inputs

Health Care, Medicine Comments Off

Document no: MEC 207/DoG/Oct2017 Original:
English
Title: Proposed Revision of the WMA Declaration of Geneva ¬
Destination: Constituent Members Action(s) required:
For Comments
Note: This revised version (as of 7 June 2017) is proposed by the DoG Workgroup who considered the comments from the
public consultation which was conducted for all experts and stakeholders by 29 May 2017. This is now open for the Constituent Members to comment no later than 31 July 2017.
Keywords Geneva, Oath, Pledge, Conduct, Discrimination, Non-Discrimination, Conscience, Dignity

No Text of current version of the Declaration of Geneva Revised draft (as of 7 June 2017)
Additions: bold/underlined
Deletions:  lined-out
Comments only: [italic] Comments
¬† WMA DECLARATION OF GENEVA WMA DECLARATION OF GENEVA ¬
New ¬† The Physician‚Äôs Oath ¬
  Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948
and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968
and the 35th World Medical Assembly, Venice, Italy, October 1983
and the 46th WMA General Assembly, Stockholm, Sweden, September 1994
and editorially revised by the 170th¬†WMA Council Session, Divonne-les-Bains, France, May 2005¬
and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006 Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948
and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968
and the 35th World Medical Assembly, Venice, Italy, October 1983
and the 46th WMA General Assembly, Stockholm, Sweden, September 1994
and editorially revised by the 170th¬†WMA Council Session, Divonne-les-Bains, France, May 2005¬
and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006
and the ¬
1. AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION: AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:
¬
2. I SOLEMNLY PLEDGE to consecrate my life to the service of humanity; I SOLEMNLY PLEDGE to consecrate dedicate my life to the service of humanity;
¬
3. I WILL GIVE to my teachers the respect and gratitude that is their due; I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
¬
    I WILL FOSTER MAINTAIN by all means in my power, the honour and noble traditions of the medical profession;  (Moved from line 7)
¬
4. I WILL PRACTISE my profession with conscience and dignity; I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;
¬
5. THE HEALTH OF MY PATIENT will be my first consideration; THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
¬
New   I WILL RESPECT the autonomy and dignity of my patient;
¬
6. I WILL RESPECT the secrets that are confided in me, even after the patient has died; I WILL RESPECT the secrets that are confided in me, even after the patient has died; ¬
7. I WILL MAINTAIN by all means in my power, the honour and the noble traditions of the medical profession; Moved between lines 3 and 4 ‚Äď see above ¬
8. MY COLLEAGUES will be my sisters and brothers; MY COLLEAGUES will be my sisters and brothers;
¬
New   I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
¬
New ¬† I WILL FOSTER my own health and ability to provide care of the highest standard; ¬
9. I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient; ¬
10. I WILL MAINTAIN the utmost respect for human life;
I WILL MAINTAIN the utmost respect for human life; ¬
11. I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat; ¬
12. I MAKE THESE PROMISES solemnly, freely and upon my honour. I MAKE THESE PROMISES solemnly, freely and upon my honour.  

Dr KK Aggarwal
National President IMA & HCFI

Do clinical practice guidelines have legal implications?

Health Care, Medicine Comments Off

Call guidelines as guidance or advisories
Dr KK Aggarwal
National President IMA
Clinical practice guidelines are becoming an increasingly common feature of the health care. The government has developed Standard Treatment Guidelines under the Clinical Establishments Act (CEA), for example, for critical care, orthopaedics, cardiovascular diseases, general surgery etc. There are 21 such guidelines. ‚ÄúTo ensure compliance with Standard Treatment Guidelines as may be determined and issued by the Central Government or State Government, as the case may be, from time to time‚ÄĚ is one of the conditions to be fulfilled for registration and renewal of a clinical establishment under CEA (Clinical Establishments Act FAQs).

The government has three functions to perform

‚ÄĘ Administrative through bureaucracy
‚ÄĘ Regulatory through Medical Council of India and state councils
‚ÄĘ Legislative through law ministry

Developing guidelines and updating them therefore is not the job of the Govt; instead it should be the job of professional bodies such as medical associations, which represent the collective consciousness of the medical fraternity. Unlike the Medical Associations, the Expert Panel enlisted by the Govt. to develop the guidelines does not represent the collective consciousness medical fraternity.

In UK, the guidelines are regularly developed by the National Institute of Clinical Excellence (NICE), Royal medical colleges and the universities.

Clinical practice guidelines are recommendations and suggestions that are evidence-based and show potential benefit or harm. They standardize treatment and improve quality of care. But they are not without their limitations. They cannot be generalized i.e. applied on each and every individual. Each patient is different and hence treatment has to be individualized. Also, western data cannot be extrapolated to our Indian settings.

There is a need for a balanced perspective.

Lawyers should really have no part to play in the development of clinical guidelines, as they are not clinicians.

The basic legal premise to work from in designing clinical guidelines is the ‚ÄúBolam principle‚ÄĚ, which would be applied in any dispute about the correctness or otherwise of a clinical guideline.
Basically, a clinical guideline would be viewed as proper if it satisfied the Bolam test.

Lord Browne-Wilkinson stated in Bolitho v City and Hackney HA [1998] Lloyd’s Rep Med 26 the test: “The locus classicus of the test for the standard of care required of a doctor or any other person professing some skill or competence is the direction to the jury given by McNair J, in Bolam v Friern Hospital Management Committee [1957] 1WLR 583,587. ‚ÄúI myself would prefer to put it this way, that he is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of men skilled in that particular art … Putting it the other way round, a man is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion who would take a contrary view.‚ÄĚ

There are many ways to treat patients and any court would look to experts in the medical or nursing professions to help them assess whether the clinical guideline used in the case was proper or not.

The views of experts are however not definitive; they may show that a reasonable body of medical opinion may have designed and used a clinical guideline in a certain way, but the judge in the case will have the final say.

Issues to be considered when developing clinical guidelines:

‚ÄĘ The objectives for the clinical guidelines need to be clear, and clearly stated. This will affect their subsequent legal standing.
‚ÄĘ The intended use and applicability of clinical guidelines should be spelt out clearly, in the introduction.
‚ÄĘ The guidelines must make clear for whom they are intended.
‚ÄĘ Clinical guidelines that no longer reflect best practice might conceivably become actionable, and developers need to incorporate specific statements about their validity and review procedure.
‚ÄĘ They should be constructed in such a way that allows deviation and does not suffocate initiative that might bring about further improvements.
‚ÄĘ The development of clinical guidelines must involve all the relevant professionals and managers.

In Jacob Mathew vs State of Punjab & Anr on 5 August, 2005, the Hon‚Äôble Supreme Court of India has acknowledged that neither the investigating officer or the complainant or judges are experts as they do not have knowledge of medicine. It also held that ‚Äúone man clearly is not negligent merely because his conclusion differs from that of other professional men ‚Ķ Differences of opinion and practice exist, and will always exist, in the medical as in other professions. There is seldom any one answer exclusive of all others to problems of professional judgment. A court may prefer one body of opinion to the other, but that is no basis for a conclusion of negligence.”

‚ÄúNon-adherence to established guidelines does not necessarily bode an adverse outcome for the defendant. Adherence to guidelines may not exonerate the defendant‚ÄĚ (J R Soc Med. 2003 Mar;96(3):133-8).

So, differ with a reason. You should be able to justify your action or inaction and explain to the Court as to why you took the decision that you did.

To remove the confusion and possible legal implications, do not call guidelines as guidelines but as ‚ÄėAdvisory‚Äô or ‚ÄėGuidance‚Äô.

Dr KK Aggarwal
National President IMA & HCFI

« Previous Entries Next Entries »