Canada’s departure from the WMA marks a missed opportunity
Just before Thanksgiving, news broke that the Canadian Medical Association (CMA) had quit the World Medical Association (WMA) at the WMA’s general assembly. The reason the CMA gave for this was plagiarism—specifically, that the incoming WMA president, Leonid Eidelman of Israel, had cribbed a substantial portion of his inaugural address from a speech previously given by Chris Simpson, CMA past president, who happened to be in attendance. A motion subsequently initiated by the CMA calling for Dr. Eidelman’s resignation failed, and the CMA walked out.
This news may have surprised many physicians both in Canada and abroad. But the relationship between the CMA and WMA had become acrimonious over the past several years. Differences on questions of governance and ethics had started to make CMA membership in the WMA uncomfortable and perhaps for some representatives untenable.
I can’t help but wonder, though: Should the CMA have left? And in leaving, could their exit have been used to bring broader concerns to light, to open an important dialogue?
Founded in Paris in 1947, the WMA was created to advocate for physician independence and ethics in practice. The CMA was a founding member association and T. Clarence Routley, a Canadian physician, served as chairperson of the key initial planning meeting in preparation for the organization’s founding. The CMA was also instrumental in supporting the development of the WMA Junior Doctors Network, the global forum for young physicians and postgraduate physicians-in-training, of which I had the privilege of serving as inaugural deputy chair in 2012.
During my term, I saw how WMA initiatives have influenced physician practice worldwide. The Declaration of Helsinki, adopted in 1964, provided the foundation for ethics in medical research through concepts such as informed consent and respect for patient autonomy. The Declaration of Geneva, adopted in 1948, provides the text for the modern Hippocratic Oath which students worldwide recite at the start of medical training. I also saw that representing 10 million practising physicians from 114 countries required WMA leadership to bridge disparate national and cultural traditions, a context that naturally fosters occasional governance challenges.
Over the past decade, the CMA has emerged as one of the more progressive voices in the room, and this has led to conflict on various issues, including the WMA’s peculiar voting system, which links the number of votes to the total fees that members have chosen to pay, a system which tends to result in a few members dominating voting and the broader discourse.
Most recently, the CMA found itself at odds with a 2005 WMA policy statement, reaffirmed in 2015, that codifies medical assistance in dying as unethical. Canadian attendees at recent meetings reported personal and vindictive attacks against CMA representatives, and expressed concerns that the friction over MAiD has thwarted Canada’s efforts to serve in WMA leadership.
Given all this, I wonder whether the plagiarized speech was truly the primary reason for the CMA’s departure, and whether it should have been identified as such. Those who support the decision say that plagiarism absolutely cannot be tolerated and would be grounds for expulsion from medical school, and that plagiarism by the incoming WMA president is representative of how far the WMA has fallen from its ideal as a defender of medical ethics.
While I can agree that the plagiarized speech is emblematic of the WMA’s ethical challenges, leaving on its account seems disproportionate. Of course, leaders of organizations must be held to a higher standard, as was the dean of the University of Alberta, Philip Baker, who resigned in June 2011 after it came to light that he had delivered a plagiarized speech. But my experience as chief resident of family medicine at St. Michael’s Hospital and even current University of Toronto guidelines suggests that expulsion is usually reserved for serious and repeated academic misconduct, with other avenues and sanctions explored prior to that drastic action.
The CMA certainly had reasons to leave the WMA. Making its departure just about plagiarism represents a missed opportunity to raise the profile of these other issues. Thinking strategically, the CMA could have pursued a more deliberate, measured exit, using the opportunity to highlight all its concerns: the plagiarism, governance, and the personal attacks and overall lack of civility in discourse with CMA representatives.
Such an approach might have even encouraged like-minded national associations to also leave. As it stands, however, no other nations have yet left—even those progressively aligned with the CMA. And the chance to unite in protest has been lost, at least for the CMA, as it is now on the outside looking in.
It’s also worth considering that despite the extant challenges, and even if the CMA felt that the WMA was not living up to its ethical ideals, all international bodies experience similar challenges in balancing viewpoints across cultural and national traditions. Many could argue that the United Nations has significant governance challenges and at times fails to live up to its stated ideals. Yet even pariah nations retain membership—because it can be easier to horse-trade within than without.
So while I understand why the CMA decided to leave, I can’t help but question whether this was truly the most effective strategy to incite change in the WMA, and whether it was deployed in the most effective manner by seemingly making it all about a plagiarized speech.
Dr. Lawrence C. Loh is adjunct professor at the Dalla Lana School of Public Health, University of Toronto, and was the inaugural deputy chair of the World Medical Association Junior Doctors Network, 2011–2012.