Medical ethics in times of armed conflict is identical to medical ethics in times of peace, as stated in the International Code of Medical Ethics of the WMA. If, in performing their professional duty, physicians have conflicting loyalties, their primary obligation is to their patients. In all their professional activities, physicians should adhere to international conventions on human rights, international humanitarian law and WMA declarations on medical ethics.
The primary task of the medical profession is to preserve health and save life. Hence it is deemed unethical for physicians to:
- give advice or perform prophylactic, diagnostic or therapeutic procedures that are not justifiable for the patient’s healthcare;
- weaken the physical or mental strength of a human being without therapeutic justification;
- employ scientific knowledge to imperil health or destroy life;
- employ personal health information to facilitate interrogation;
- condone, facilitate or participate in the practice of torture or any form of cruel, inhuman or degrading treatment.
During times of armed conflict and other situations of violence, standard ethical norms apply, not only with regard to treatment but also to all other interventions, such as research. Research involving experimentation on human subjects is strictly forbidden on all persons deprived of their liberty, especially civilian and military prisoners and the population of occupied countries.
The medical duty to treat people with humanity and respect applies to all patients. The physician must always give the necessary care impartially and without discrimination on the basis of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other similar criterion.
Governments, armed forces and others in positions of power should comply with the Geneva Conventions to ensure that physicians and other healthcare professionals can provide care to everyone in need in situations of armed conflict and other situations of violence. This obligation includes a requirement to protect healthcare personnel and facilities.
Whatever the context, medical confidentiality must be preserved by the physician. However, in armed conflict or other situations of violence – as well as in peacetime – there may be circumstances in which a patient poses a significant risk to other people, and physicians will need to weigh their obligation to the patient against their obligation to other individuals threatened.
Privileges and facilities afforded to physicians and other healthcare professionals in times of armed conflict and other situations of violence must never be used other than for healthcare purposes.
Physicians have a clear duty to care for the sick and injured, and should recognise the special vulnerability of some groups, including women and children. Provision of such care should not be impeded or regarded as any kind of offence. Physicians must never be prosecuted or punished for complying with any of their ethical obligations.
Physicians have a duty to press governments and other authorities to provide the infrastructure that is a prerequisite to health, including potable water, adequate food and shelter.
Where conflict appears to be imminent and inevitable, physicians should, as far as they are able, ensure that authorities are planning for the protection of the public health infrastructure and for any necessary repair in the immediate post-conflict period.
In emergencies, physicians are required to render immediate attention to the best of their ability. Whether civilian or combatant, the sick and wounded must receive promptly the care they need. No distinction shall be made between patients except those based upon clinical need.
Physicians must be granted access to patients, medical facilities and equipment and the protection needed to carry out their professional activities freely. Such access must include patients in detention centres and prisons. Necessary assistance, including unimpeded passage and complete professional independence, must be granted.
In fulfilling their duties and where they have the legal right, physicians and other healthcare professionals shall be identified and protected by internationally recognised symbols such as the Red Cross, Red Crescent or Red Crystal.
Hospitals and healthcare facilities situated in areas where there is either armed conflict or other situations of violence must be respected by all combatants and media personnel. Healthcare given to the sick and wounded, civilians or combatants, cannot be used for publicity or propaganda. The privacy of the sick, wounded and dead must always be respected. This includes visits from important political figures for media purposes and when political figures are among the wounded and sick.
Physicians must be aware that during armed conflict or other situations of violence, healthcare becomes increasingly susceptible to unscrupulous practice and the distribution of poor quality or counterfeit materials and medicines, and attempt to take action on such practices.
The WMA supports the collection and dissemination of data related to assaults on physicians, other healthcare personnel and medical facilities, by an international body. Such data are important to understand the nature of such attacks and to set up mechanisms to prevent them. Assaults against medical personnel must be investigated and those responsible must be brought to justice.
Next card: Code of conduct (Appendix B)