Adopted by the 2" General Assembly of the World Medical Association, Geneva, Switzerland, September 1948, amended by the 22nd World Medical Assembly Sydney, Australia, August 1968, and the 35th World Medical Assembly, Venice, Italy, October 1983.

AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:

I SOLEMNLY PLEDGE myself to consecrate my life to the service of humanity;

I WILL GIVE to my teachers the respect and gratitude that is their due;

I WILL PRACTICE my profession with conscience and dignity;

THE HEALTH OF MY PATIENT will be my first consideration;

I WILL RESPECT the secrets, which are confined in me, even after the patient has died;

I WILL MAINTAIN by all means in my power, the honour and the noble traditions of the medical profession;

MY COLLEAGUES will be my brothers;

I WILL NOT PERMIT consideration of religion, nationality, race, party politics or social standing to intervene between my duty and my patient,

I WILL MAINTAIN the utmost respect for human life from it's beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity;

I MAKE THESE PROMISES solemnly, freely and upon my honour;

The World Medical Association, Inc., recognizing the importance of the physician's independence and professional freedom, hereby adopts the following declaration of principles:
Physicians must recognize and support the rights of their patients, particularly as set forth in the World Medical Association Declaration of Lisbon (1981).

Physicians must have the professional freedom to care for their patients without interference. The exercise of the physician's professional judgment and discretion in making clinical and ethical decision in the care and treatment of patients must be preserved and protected.

Physicians must have the professional independence to represent and defend the health needs of patients against all who would deny or restrict needed care for those
who are sick or injured.

Within the context of their medical practice and the care of their patients, physicians should not be expected to administer governmental or social priorities in the allocation of scare health resources. To do so would be to create a conflict of interest with the physician’s obligation to his patients, and would effectively destroy the physician’s professional independence, upon which the patient relies.

While physicians must be conscious of the cost of medical treatment and actively participate in cost containment efforts within medicine, it is the physician’s primary obligation to represent the interests of the sick and injured against demands by society for cost containment that would endanger patient’s health and perhaps patient’ life.

By providing independence and professional freedom for physicians to practice medicine, a community assures the best possible health care for its citizens, which in turn contributes to a strong and secure society.

Life is short and the Art (of medicine) long, opportunity is fleeting, judgment difficult, and experience dangerous. The physician must do the right thing right time. – First aphorism of Hippocrates translated by Adams, a nineteenth century Aberdeen doctor and classical scholar.

WORLD MEDICAL ASSOCIATION DECLARATION OF MADRID ON PROFESSIONAL AUTONOMY AND SELF- REGULATION
Adopted by the 39th World Medical Assembly,
Madrid, Spain, October 1987.

The World Medical Association, Inc., having explored the importance of professional autonomy and self-regulation of the medical professional around the world, and reorganizing the problems and the current challenges to professional automony and self-regulation, hereby adopts and following declaration:

1. The central element of professional autonomy is the assurance that individual physicians have the freedom to exercise their professional judgment in the care and treatment of their patients, as set out more fully in the World Medical Association Declaration on Physician Independence and Professional Freedom, adopted in October, 1986 (see document 17.0).

2. The World Medical Association and its National Medical Associations re-affirm the importance of professional autonomy as an essential component of high quality medical care and therefore benefit due to the patient that must be preserved. The World Medical Association and its National Medical Associations therefore re-dedicate themselves to maintaining and assuring the continuation of professional autonomy in the care of patients, which is, an essential principle of ethics.

3. As a corollary to the right of professional autonomy, the medical profession has a continuing responsibility to be self-regulating. In addition to any other source of regulation that may be applied to individual physicians, the medical profession itself must be responsible for regulating the professional conduct and activities of individual physicians.

4. The World Medical Association urges its National Medical Associations to establish, maintain and actively participate in a system of self-regulation for the physicians in their respective countries. It is this dedication to effective self-regulation that will ultimately assure professional autonomy in patient care decision.

5. The equality of the care provided to patients and the competency of the physician providing that care must always be a primary concern in any system of self-regulation. Physicians have the expertise to make the necessary evaluation. These evaluations must be used for the benefit of patients to assure them continued quality care by competent physicians. Included in this area of responsibility is the need to monitor advances in scientific medicine and the use of therapeutic regimens that are safe and effective. Experimental procedures must comply with the protections required by the World Medical Association Declaration of Helsinki and other protections as may be required in each country. Discredited scientific theories must not be used on patients.

6. Cost consciousness is an essential element of self-regulation. The highest quality of care can be justified only by assurances that the cost of such care will allow access to that care for all citizens. Again, physicians are particularly qualified to make the evaluations that are necessary for cost containment decisions. National Medical Associations must, therefore, include cost containment activities in their respective system of self-regulation. Common issues in cost containment activities relate to methods of delivery of medical care, access to hospital and surgery, and the appropriate use of technology. Cost containment activities must not be used to deny patients needing access to necessary medical care. Nor should over-utilization of medical facilities be permitted to drive the cost of medical care upwards so that it will not be available to all who may need the particular care.

7. Finally, the professional activities and the conduct of physicians must always be within the bounds of the professional code of ethics or the principles of medical ethics governing physicians in each country. National Medical Associations must promote ethical conduct among physician for the benefit of their patients. Ethical violations must be promptly corrected, and the physicians guilty of ethical violations must be disciplined and rehabilitated. This is a responsibility that only National Medical Associations can undertake and perform effectively and efficiently.

8. There are, of course, many other areas of self-regulation for which National Medical Associations are urged to assist each other in coping with new and developing problems. The exchange of information and experiences between National Medical Associations is encouraged and the World Medical Association will assist in facilitating this exchange of information to improve self-regulation.

9. The World Medial Association and its National Medical Associations must also educate the public generally as to the existence of an effective and responsible system of self-regulation by the medical profession in each country. The public must come to recognize that it can rely on this system of self-regulation for an honest and objective evaluation of the issues relating to the practice of medicine and the care and treatment of patients.