Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies
June 2015
Within the framework of the Health Care in Danger project, the World Medical Association (WMA), the International Committee of Military Medicine (ICMM), the International Council of Nurses (ICN) and the International Pharmaceutical Federation (FIP) were consulted by the ICRC with the aim of these organizations agreeing on a common denominator of ethical principles of health care applicable in times of armed conflict and other emergencies. The following document, which is the result of these consultations, is without prejudice to existing policy documents adopted by these organizations.

Civilian and military health-care organizations share the common goal of improving the safety of their personnel and other health assets and the delivery of impartial and efficient health care in armed conflicts and other emergencies,

Referring to the principles of humanity, whereby human suffering shall be prevented and alleviated wherever it may be found and impartiality, whereby health care shall be provided with no discrimination;

Bearing in mind the standards of international humanitarian law, in particular the 1949 Geneva Conventions and their 1977 Additional Protocols, and of international human rights law, specifically the Universal Declaration of Human Rights (1948) and the International Covenants on Civil and Political Rights and on Economic, Social and Cultural Rights (1966);

Considering the principles of professional ethics adopted by health-care professional associations, including the WMA Regulations in Times of Armed Conflict and Other Situations of Violence;

Endorse the following ethical principles of health care:

GENERAL PRINCIPLES
1. Ethical principles of health care do not change in times of armed conflict and other emergencies and are the same as the ethical principles of health care in times of peace.

2. Health-care personnel shall at all times act in accordance with relevant international and national law, ethical principles of health care and their conscience. In providing the best available care, they shall take into consideration the equitable use of resources.

3. The primary task of health-care personnel is to preserve human physical and mental health and to alleviate suffering. They shall provide the necessary care with humanity, while respecting the dignity of the person concerned, with no discrimination of any kind, whether in times of peace or of armed conflict or other emergencies.

4. Privileges and facilities afforded to health-care personnel in times of armed conflict and other emergencies are never to be used for purposes other than for health-care needs.

5. No matter what arguments may be put forward, health-care personnel never accept acts of torture or any other form of cruel, inhuman or degrading treatment under any circumstances, including armed conflict or other emergencies. They must never be present at and may never take part in such acts.

RELATIONS WITH PATIENTS
6. Health-care personnel act in the best interest of their patients and whenever possible with their explicit consent. If, in performing their professional duties, they have conflicting loyalties, their primary obligation, in terms of their ethical principles, is to their patients.

7. In armed conflict or other emergencies, health-care personnel are required to render immediate attention and requisite care to the best of their ability. No distinction is made between patients, except in respect of decisions based upon clinical need and available resources.

8. Health-care personnel respect patients’ right to confidentiality. It is ethical for health-care personnel to disclose confidential information only with the patient’s consent or when there is a real and imminent threat of harm to the patient or to others

9. Health-care personnel make their best efforts to ensure respect for the privacy of the wounded, sick and deceased, including avoiding the use of health care for the wounded and sick, whether civilian or military, for publicity or political purposes.

PROTECTION OF HEALTH-CARE PERSONNEL
10. Health-care personnel, as well as health-care facilities and medical transports, whether military or civilian, must be respected by all. They are protected while performing their duties and the safest possible working environment shall be provided to them.

11. Safe access by health-care personnel to patients, health-care facilities and equipment shall not be unduly impeded, nor shall patients’ access to health-care facilities and health-care personnel be unduly impeded.

12. In fulfilling their duties and where they have the legal right, health-care personnel are identified by internationally recognized symbols such as the Red Cross, Red Crescent or Red Crystal as a visible manifestation of their protection under applicable international law.

13. Health-care personnel shall never be punished for executing their duties in compliance with legal and ethical norms.

FINAL
14. By endorsing these ethical principles of health care, the signatory organizations commit themselves to work for the promotion and implementation thereof wherever possible, including by appropriate dissemination amongst their members.

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Press Release
Common ethical principles of health care in conflict and other emergencies
30 June 2015
The World Medical Association (WMA), the International Committee of Military Medicine (ICMM), the International Council of Nurses (ICN), and the International Pharmaceutical Federation (FIP), representing more than 30 million people from both the military and civilian realms, have adopted the “Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies”, a first-of-its-kind code of ethics that provides a common core for these major international health care organizations.
This document marks an important step towards the protection of health care, with the signatory’s organizations showing a cohesive front against all forms of disrespect of ethical principles affecting the access to and the delivery of health care in armed conflict and other emergencies.

Common code to protect health care workers from violence
Consistent information gathered by the ICRC through the Health Care in Danger initiative shows that, in armed conflict and other emergencies, health–care personnel are often coerced to act against health-care ethics, or are victims of threats and subjected to deprivation of liberty for acting in accordance with the ethical principles of their profession.
Within the framework of the HCiD project, WMA, ICMM, ICN and FIP were consulted by the ICRC with the aim of these organizations agreeing on a common denominator of ethical principles of health care applicable in times of armed conflict and other emergencies. The document is the result of these consultations.
With the adoption of the Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies, the five organizations reinstate the importance of respect of ethical principles of health care for the full implementation of International Humanitarian Law and the protection of health care.
The code enumerates the principles guiding the relationship between patients and health-care workers, and contemplates issues such as discrimination, abuse of privileges, confidentiality, and torture. The principles underlying this relationship apply in times of armed conflict and other emergencies, thereby facilitating the oft-arduous application of ethics in wartime. In this sense, these ethical principles of health care constitute a significant negotiation tool for health-care personnel (in and beyond the humanitarian domain) with the authorities and other relevant actors.

About
The International Pharmaceutical Federation is the global federation of national associations of pharmacists and pharmaceutical scientists, and is a non-governmental organisation in official relations with the World Health Organization. With 132 member organisations FIP represents more than three million experts in medicines, supporting the responsible use of medicines around the world.
The World Medical Association is the global federation of National Medical Associations representing the millions of physicians worldwide. Acting on behalf of patients and physicians, the WMA endeavors to achieve the highest possible standards of medical care, ethics, education and health-related human rights for all people.
The ICMM is an International and Intergovernmental organization created in 1921 whose primary mission is to maintain and strengthen the bonds of cooperation and knowledge between the Armed Forces Medical Services of all Member States.
The International Council of Nurses is a federation of more than 130 national nurses associations representing the millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality nursing care for all and sound health
policies globally.

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Peter Maurer on ethical principles of health care in conflict
30 June 2015
Speech given by Peter Maurer, President of the ICRC, at the launch of the “Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies.”
[Excerpts]

Dear colleagues, Dear friends,
The nature of humanitarian work often has me deliver speeches with words of warning and caution, and with descriptions of the particularly distressing situations in which victims of violence find themselves. I am glad to deviate from such patterns today, at the launch of our “Ethical principles of health care in times of armed conflict and other emergencies”.

Agreeing on these principles is indeed a substantive achievement and I would like to thank the World Medical Association (WMA), the International Committee of Military Medicine (ICMM), the International Council of Nurses (ICN) and the International Pharmaceutical Federation (FIP) for their participation and commitment to this process under the auspices of the ICRC.

The ethical principles we are launching today are a ground-breaking document because now, for the first time, our global associations have a common and concise set of shared principles. They will apply to more than 30 million professionals, civilian and military, who may face ethical dilemmas in times of armed conflict and other emergencies…

…This set of principles is a great achievement and demonstrates the capacity of a single sector to produce far-reaching ethical standards. The process through which we achieved this result is a perfect example of what I like to describe as principled pragmatism – where professional experience meets normative frameworks.

The endorsement of the ethical principles also demonstrates the outstanding commitment of health care professionals to preserve the integrity of health care staff and their resolve to lead without waiting for a governmental process – while it is critically relevant, it may take some more years to materialize.

Indeed, professional ethics transcend borders and political interests. The principles can therefore be seen as an articulation by individuals and civil society of what is acceptable and what is unacceptable behavior. Our common purpose today is to discuss how we are going to disseminate these rules and give them more leverage with different stakeholders.

We hope that you will use your own power, influence and your different networks to encourage the establishment of robust national legislations and accountability mechanisms…
Peter Maurer, President of the ICRC