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شبكة العلوم النفسية العربية



OKASHA ; Pr. Ahmed

WPA President

Chairman WPA Ethics Committee

Word Psychiatry Volume 1 N° 2 – June 2002



q       Full text / Texte  entier / النص الكامل


     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).



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


Document Code OP.0005


ترميز المستند OP.0005


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