Parsa-Parsi et al bring attention to the World Medical Association (WMA) and transparency to its International Code of Medical Ethics (ICoME) revisions.1 We value their report and the revised ICoME but explain here that the ICoME cannot reflect consensus among all WMA members, or the wider medical profession, given structural and epistemic injustices that restrain low-income and middle-income country (LMIC) physicians from participating in activities such as WMA revisions. Such injustices overlook experiences and contributions of those from LMICs and marginalised groups, hindering their access to and influence within medicine.2 They also undermine access to information about, and from, the WMA. Recruiting new members from, and better engaging members in, LMICs would strengthen the WMA and its influence across the medical profession, and better elevate environmental sustainability as a biomedical and bioethical concern. This would be beneficial because there is controversy among physicians, bioethicists and other stakeholders about the relevance of environmental sustainability to medicine.3 4 That its addition to the ICoME was ‘uncontentious’ hints at structural and epistemic injustices in the revision process and homogeneity of those most involved in the revisions.

Based on our observations as medical educators, it appears that few medical students and physicians at our institution, and few across the Caribbean and …