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THE DECLARATION OF
MADRID & ITS IMPLEMENTATION WPA President Chairman WPA Ethics Committee
Word Psychiatry Volume 1 N° 2 – June 2002 |
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Full text / Texte entier
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النص الكامل |
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The
first position statement of the psychiatric profession concerning ethical
issues was the Declaration of Hawaii. This was drafted in 1977 to help psychiatrists in conflicts of loyalty
in contemporary societies. A major trigger was the political misuse of
psychiatry in countries such as the former Soviet Union, Romania and South
Africa, that came to public awareness during the early 1970s. The very first
paragraph of the Declaration is concerned with the ethical problem of the
political misuse of psychiatric concepts, knowledge and techniques. At the 1993 World Congress of
Psychiatry in Rio de Janeiro, the WPA gave its Ethics Committee the mandate
to update the Hawaii Declaration and to develop ethical guidelines for
specific situations. The outcome of that process, the Declaration of Madrid,
was drafted several times by the WPA Ethics Committee, reviewed by the WPA
Council, then revised accordingly, reviewed by the WPA Executive Committee
and then revised more than once, until it was presented to the WPA General
Assembly in Madrid in August 1996. The preparations for the
Declaration of Madrid involved the collection of data on professional ethics
in the field of medicine and psychiatry from all WPA member societies. Those
which responded provided us with a richness of perspectives and points of
view, that helped to widen our horizon and establish more and more the
complexity of the issues that we were addressing. Upon the recommendation of
the WPA Long Range Planning Committee, we also collected information on the
existence of codes of ethics for psychiatrists in the different countries. We
received responses from 21 member societies. Of those societies, six followed
the general medical code and two were preparing a code of ethics for psychiatrists
at the time of the survey. Furthermore, ail member societies received a
checklist he for the assessment of the human rights conditions of the
mentally disordered in their countries, prepared by the Division of Mental
Health of the World Health Organization in or Geneva. A response was received
,y- from 23 countries. In addition to the rich
information which we drew out of those mail surveys, several of the
respondents expressed their
interest in the issue n- and their willingness to contribute to a further
development of the process. In a- other words, the preparations for the
Declaration of Madrid went beyond y- the development of a document into
creating a circle of psychiatrists interested in the field of professional
ethics. The collected material was
shared and discussed among the
members of the Ethics Committee. Position papers circulated among the members
and eventually a draft was prepared and presented to the Executive Committee
for comments. A process of revising, editing and reformulating it extended
over a period of approximately six months, after which the draft was
presented to the WPA -Council, whose comments were taken into consideration
before the final draft was presented to the WPA General Assembly in Madrid,
1996. The first section of the
Declaration of Madrid outlines the ethical commitments of the profession and
the theoretical assumptions upon which these are based. lt. acknowledges that
medical professionals are facing new ethical dilemmas resulting from . increasingly complex medical
interventions, new tensions between the physician and the patients, and new
social expectations from the physician, and that, although there may be
cultural, social and national differences, yet the need for ethical con-duet
and continual review of ethical standards is universal. It also emphasizes
that ethical behavior is based on the individual psychiatrists sense of
responsibility towards the patient and his/her judgment in determining what
is correct and appropriate conduct. The second section
contains seven general guidelines that focus on psychiatry as a medical
discipline concerned with the provision of the best treatment for mental
disorders, with the rehabilitation of individuals suffering from mental
illness and with the promotion of mental health. It states that it is the
duty of psychiatrists to keep abreast of scientific- developments, to convey
updated knowledge to others, to ensure that involuntary admission is for the
welfare of patients, and to inform the person being assessed about the
purpose of the intervention. It also stresses that the patient should be
accepted as a partner by right in the therapeutic process, that the
therapist-patient relationship must be based on mutual trust and respect to
allow the patient to make free and informed decisions ,and that information
obtained in the therapeutic relationship should be1kept in confidence and
used, only and-exclusively, for the purpose of improving the mental health of
the patient. The third section
of the Declaration deals with the need to develop specific guidelines on
special issues. Guide-lines approved by the 1996 General Assembly of the WPA
included ethical positions regarding euthanasia, torture, death penalty,
selection of sex and organ transplantation. After
the 1996 Congress, the WPA Ethics Committee continued to draft further
specific guidelines. Three were endorsed during the 1999 General Assembly,
dealing with psychiatrists addressing the media, psychiatrists and
discrimination on ethnic and cultural grounds, and psychiatrists and genetic
research and counseling. Currently the Ethics
Committee has drafted further specific guidelines to be sent to all WPA
components for feedback and to be endorsed at the next World Congress of Psychiatry in Yokohama, Japan, August 2002.
Issues involved include ethics
of psychotherapy, conflict of interest in relationship with industry, conflicts arising with third party payers, and violation of
the clinical boundaries and
trust between psychiatrists and
patients. The Declaration of
Madrid has been translated into
many languages and constitutes
the ethical codes and principles
by which WPA member societies
should abide. Since the approval
of the Declaration, the WPA has
been carrying out opinion surveys
among its member societies regarding the activities of its various components. The WPA 2001
survey revealed that 76.1% of
member societies believe that
the WPA has fulfilled its
statutory purpose of promoting the highest ethical standards in psychiatric work. This is
opposed to 65.6% who gave the
same rating in the 1998 survey.
16.8% of societies were not in agreement
with that position and 7.1% did
not provide a rating. The
quality of the WPA Declaration of Madrid and its additional guidelines obtained one of the highest
ratings (39% for excellent and
76% for good or excellent). At
present, almost ail WPA member
societies have endorsed the
Declaration and its specific guide-
lines, and the WPA is encouraging member societies to have their own national ethics committee
(currently existing in 57.6% of
the societies). |
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So as to publish all pages in 3 languages Please participate in the
translation of this article in French and Arabic and send it to the Arabic edition or the French
edition |
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Document Code OP.0005 |
ترميز المستند OP.0005 |
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