AAPS News August 2014 – Consent

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AAPS News August 2014 – Consent
Aug 5, 2014
Volume 70, no. 8 August 2014

The Nuremberg trials established a precedent for international standards for human rights.

One fond hope expressed by American prosecutor Robert H. Jackson, former Attorney General and then-Supreme Court Justice, as portrayed in the television miniseries Nuremberg, was that countries would stop waging wars of aggression. This hope was immediately dashed as the Soviet Union, one of the four powers sitting in judgment on Germany, invaded Eastern Europe.

The Nuremberg tribunals invented the concepts of “war crimes” and “crimes against humanity.” These included the atrocious Nazi human experiments. The doctrine of informed consent is one legacy—but as the Nuremberg Code recognizes, consent is not enough. Experiments that do harm without commensurate prospect of benefit to the subjects are never acceptable. These principles are already being eroded, or even inverted (also see AAPS News, November 2012).

When Is Consent Not Needed?

While “it will often be unethical” to go forward with comparative-effectiveness research (CER), write Ruth R. Faden, Ph.D., M.P.H., et al, “in a mature learning health care system with ethically robust oversight policies and practices, some randomized CER studies may justifiably proceed with a streamlined consent process and others may not require patient consent at all” (NEJM 2/20/14). Institutions such as the Berman Institute of Bioethics at Johns Hopkins, the Kennedy Institute of Ethics at Georgetown University, and the National Institutes of Health are apparently developing a Common Purpose Framework for ethics—which includes “reducing health inequalities in populations.”

In the “integrated-consent” model, the “generation of knowledge” would be “embedded into the core of the practice of medicine,” write Scott Y.H. Kim, M.D., Ph.D., and Franklin G. Miller, Ph.D. The traditional approach to informed consent is “ethically unnecessary and may in fact compromise the integrity of such studies,” they write (NEJM 2/10/14).

Consent Is Not Justification

If one consents—or even demands—to be killed, maimed, enslaved, or addicted, whether as research or treatment, is a physician or official justified in performing the action? Presumably, the person is mentally competent, or is a duly authorized surrogate.

At the Doctors’ Trial, charges against Karl Brandt and others included the secret killing of the aged, insane, deformed children, and incurably ill, first at asylums in Germany, then in the camps and occupied territories (http://tinyurl.com/ybu2tvo). Abortion was also considered both a war crime and a crime against humanity. It was used by the Nazis to further their genocidal and “Germanification” goals. Defendants tried to argue that it was “voluntary,” but judges evidently considered it a crime even so (http://tinyurl.com/kyxo37j).

Legalized euthanasia is becoming more widespread (AAPS News, July 2014). In Belgium, children can now consent to be euthanized, as long as a multidisciplinary team has examined the child’s “capacity for discernment” (JAMA 5/21/14).

Consent is the only boundary for sexual activity, according to ObamaCare-funded sex education by Planned Parenthood. As documented on undercover videos, teenagers are told that sado-masochism, bondage/domination, pornography, and multiple partners are normal forms of “exploration” (http://liveaction.org).

Foundation for Ethical Principles

The Palace of Justice, where the Nuremberg trials were held, had the Decalogue displayed on the wall—ironically, in the very place where the Nazis deprived Jews of their rights.

Sir William Blackstone, author of Commentaries on the Laws of England, the law book in colonial America, wrote: “Upon these two foundations, the law of nature and the law of revelation (the law of nature’s God), depend all the human laws; that is to say, no human laws should be suffered to contradict these.”

The Enlightenment severed political authority from a divine source. In 1762, Rousseau first described the social contract: “democratic governance, in which individual citizens exchange some individual freedom for shared state protection” (Wynia et al., JAMA 2/26/14). John Locke wrote of the “consent of the governed,” incorporated into the Declaration of Independence by Thomas Jefferson. What does this mean when individuals object to a political decision? Christopher Ferrara writes: “The paradoxical result of logical individualism and final democracy will be subjugation by the collective” (Liberty: the God That Failed, 2012).

Coerced “Consent”

It’s time for a “new shared social contract between health care professionals and society,” with a “transdisciplinary code of ethics” to “meet contemporary needs,” according to the Institute of Medicine (Wynia, et al.). “Healthy living needs global governance,” writes Lawrence O. Gostin, of the WHO Collaborating Center on Public Health Law and Human Rights at Georgetown University, to curb non-communicable diseases and prevent “widening of health disparities” (Nature 7/10/14).

Adopted “by acclamation” in 2005, the Universal Declaration on Bioethics and Human Rights (http://tinyurl.com/kuch7aa) lacks enforcement—for now (J Legal Med, April-June 2014).

Hermann Göring Quotes Roosevelt on Democracy

“I consider the Leadership Principle necessary because the system which previously existed, and which we called parliamentary or democratic, had brought Germany to the verge of ruin. I might perhaps in this connection remind you that your own President Roosevelt, as far as I can recall…declared, ‘Certain peoples in Europe have forsaken democracy, not because they did not wish for democracy as such, but because democracy had brought forth men who were too weak to give their people work and bread, and to satisfy them. For this reason the peoples have abandoned this system and the men belonging to it.’ There is much truth in that statement. This system had brought ruin by mismanagement and according to my own opinion, only an organization made up of a strong, clearly defined leadership hierarchy could restore order again. But, let it be understood, not against the will of the people, having in the course of time, and by means of a series of elections, grown stronger and stronger, had expressed their wish to entrust their destiny to the National Socialist Leadership” (Nuremberg trial transcript).

The Olds and Milner Experiment

While doing sleep research in 1954, James Olds and Peter Milner inserted electrodes into a rat’s brain and serendipitously discovered the “pleasure center.” If allowed to do so, rats would forgo food and drink, and self-stimulate until they died of exhaustion (http://tinyurl.com/lox4bpl). Such behavior might be described as addictive or obsessed.

Post Nuremberg

  • The U.S. Environmental Protection Agency (EPA) advertises for “overweight and out of shape” people (http://tinyurl.com/mmaxqcw) to participate in research involving exposure to air pollutants in a concentration much higher than a level that it tells Congress can cause instant death. The only purpose is to try to harm people in order to justify draconian regulations (http://tinyurl.com/oua3whm).
  • In a secret 20-year experiment, Facebook shows “evidence of massive-scale emotional contagion through social networks” (PNAS 6/17/14). Users consented by ticking a box. The “extreme response” to this study might drive social trials underground, writes Michelle Meyer, who disagrees with the sweeping condemnations (Nature 7/17/14).
  • Planned Parenthood claims to be “fighting to end racial health disparities”; 79% of its abortion centers are located in black or Hispanic neighborhoods. Abortion rates are five times higher for blacks. Chlamydia is seven times more prevalent, and gonorrhea 17 times higher in blacks than in whites (http://tinyurl.com/kzqd7pt).

♦ ♦ ♦
“The truth must be repeated again and again, because error is constantly being preached…. And not only by isolated individuals, but by the majority. In the newspapers and encyclopedias, in the schools and universities, everywhere error is dominant, securely…ensconced in public opinion.”
Johann Wolfgang von Goethe, 1828

UN Supports Natural Family

The UN Human Rights Council passed a long-delayed resolution stating that the family is the “natural and fundamental unit of society,” and the “natural environment” for the education and development of children (http://tinyurl.com/mct52hr). Advocates of “LGBT” rights failed in an effort to insert a statement about “various forms of the family,” and the U.S. and European nations voted against the resolution. The vote was 26 for (including India, China, sub-Saharan African and Islamic nations), 14 against, and 6 abstentions. Russia led the effort to pass the resolution, and while some hailed Putin as a world “redeemer” from secularism and homosexuality, his main motive was probably to promote Russian foreign policy, opines Robert Zubrin (http://tinyurl.com/nbcmpmv). Like the rights of corporations such as Hobby Lobby, the rights of families detract from individual [LGBT] rights, states Jay Michaelson (http://tinyurl.com/mqvf264). But whether we agree or disagree with a particular declaration, the basic question concerns the rights of the UN.

Consent and Distant Consequences

While individuals may consent to research, treatment, or a sexual act based on many short-term considerations, there are long-term, transgenerational consequences to individual acts and radical social experimentation.

Many media outlets announced that “kids from same-sex families fare as well as their peers,” based on the Australian Study of Child Health in Same-Sex Families (ACHESS), the largest study of its kind. It is based on a “convenience” (self-selected) sample of 315 same-sex attracted adults responsible for 500 children. There was no independent follow-up of grown children (http://tinyurl.com/mgwuz6e).

The New Family Structures Study (NFSS) sent a survey to some 15,000 randomly selected adults aged 18-39 and interviewed some 3,000 respondents, of whom 248 reported that at least one parent had a same-sex relationship. Author Mark Regnerus concluded that children did best when they spent their entire childhood with their married mother and father (Soc Sci Res 2012:41:752-770, 1367-1377). Regnerus has been pilloried as “shameless” (Slate, 3/4/14).

In 1996, Brian Fitzpatrick wrote that society’s embrace of sexual immorality brings about the downfall of civilizations. Studies of 86 civilizations from Rome to Tahiti showed that society reaches the highest level only in cultures that practice “absolute monogamy”: lifetime union of one man and one woman. Both men and culture are degraded when a society becomes “sexually obsessed” (http://tinyurl.com/p3zy8pq).

AAPS Calendar

Sept. 4-6. 71st annual meeting, Charleston, SC.

ACTION OF THE MONTH

If you have not already done so, click on the “sign up for alerts” blue box on http://www.aapsonline.org, and forward alerts to you email list or social-media contacts.

Judgment at Nuremberg

This 1961 American film, starring Spencer Tracy as chief American judge Dan Haywood, is based on the third of thirteen trials for Nazi war crimes., in which charges were brought against 16 functionaries in the Nazi Ministry of Justice. In the film, four Nazi judges were in the dock, including Ernst Janning, a composite character represented as a famous aristocratic legal scholar, a drafter of the Weimar constitution, who detested the Nazis. Defense counsel made the argument that if Janning had resigned, he would simply have been replaced by someone more brutal. And is it not the responsibility of judges to carry out the law, even if they disagree with it? The film raises many questions about the duties of the legal profession under an unjust regime (http://tinyurl.com/krgez47). Had judges resisted instead of pandering to the Nazis, could the Holocaust have been prevented?

Memorable lines at the end of the film:

Ernst Janning: Judge Haywood…the reason I asked you to come: Those people, those millions of people…I never knew it would come to that. You must believe it, you must believe it!

Judge Haywood: Herr Janning, it “came to that” the first time you sentenced a man to death you knew to be innocent.

Hobby Lobby: Narrow Wedge of Freedom

In a 5-to-4 decision in Burwell v. Hobby Lobby, the U.S. Supreme Court ruled that owners of a closely-held corporation cannot be forced to violate their religious beliefs by paying for insurance that covers abortifacients. The majority assumed that the government does have a compelling interest in giving women cost-free access to all FDA-approved methods of birth control, but concluded that the HHS mandate did not constitute the least restrictive means of achieving it, as required by the Religious Freedom Restoration Act (RFRA).

Lawyers for Hobby Lobby said that the company could have faced $26 million per year in federal penalties had they dropped all workers’ insurance plans, or $475 million per year for offering insurance without the contraceptive coverage.
The Court’s decision was immediately criticized by the American Medical Association (AMA), the American Nurses Association, the American Academy of Family Physicians (AAFP), and the American Congress of Obstetricians and Gynecologists (ACOG) for “obstructing evidence-based practices in medicine,” allowing employers to “meddle in the exam room,” and intruding into the patient-physician relationship (Modern Healthcare 7/1/14).

AAPS filed an amicus brief in support of Hobby Lobby (AAPS News, March 2014 and http://tinyurl.com/m4mletq).

Economist Uwe Reinhardt asked why employers should choose their workers’ health insurance (NYT 7/3/14).

Editors of the New England Journal of Medicine write that “contraception [is] at risk.” Since contraception is a “compelling public health need,” and saves money for the state, “the welfare of the patient must trump the religious convictions of her employer.” Next, employers might offer policies that did not cover blood transfusions, mental health services, etc. (NEJM 1/2/14)—or any type of contraception, including the 16 types to which the Green family does not object.

Roman Catholics might be the last major group to register opposition, but general acceptance of contraception is relatively recent. Sigmund Freud wrote: “The abandonment of the reproductive function is the common feature of all perversions.” Mahatma Gandhi wrote: “Artificial methods [of contraception] are like putting a premium on vice…. As it is, man has sufficiently degraded women for his lust, and artificial methods, no matter how well-meaning the advocates may be, will still further degrade her” (http://tinyurl.com/lmztr7e). Gandhi obviously held a different view of the “war on women” than U.S. Democrats do.

The “LGBT community” worried about a slippery slope, such as denying coverage for HIV drugs or hormones for transgendered persons. They were somewhat reassured by Justice Alito’s statement that the decision did not provide a way to cloak discrimination as religious practice (Washington Post 6/30/14).

The “Women’s Health Protection Act” (S. 1696), introduced in November 2013, is being pushed by Democrats as an end-run around the decision. This would “supersede anyone’s rights of religious conscience not to participate in abortion,” writes Ken Klukowski (http://tinyurl.com/qbkqpl9). According to Americans United for Life, this “Gosnell Prerogative Act” would invalidate hundreds of state laws, including health and safety regulations on abortion clinics or requirements for informed consent (http://tinyurl.com/mb22ukj). This is despite growing evidence of abortion risks. Contrary to a recent statement by “100 professors” published in AJOG in September 2013, the safety of elective abortion is disputed by many obstetricians (Issues in Law and Medicine, spring 2014).

Conscientious objection to abortion and contraception is under attack worldwide, writes Peter Saunders (http://tinyurl.com/lgpftvy). In Canada, doctors who do not want to prescribe contraception had better not work in remote locations (Frontpage Mag 7/16/14).

Consent Forbidden

The U.S. Supreme Court declined to hear Liberty Council’s petition in Pickup v. Brown, challenging California’s ban on “change therapy.” This forbids licensed counselors to offer, or minor clients and their parents to receive, any counsel to change unwanted same-sex attractions, behavior, or identity (http://tinyurl.com/myjxbf6). The ban violates the long-established principle that the client, not the therapist, determines the goal of therapy, writes Peter Spriggs. At hearing on a similar ban before the D.C. City Council, ex-gays were said to be suffering from an “illness” of “internalized hatred,” and heterosexuals who support the right of homosexuals to choose to seek change were said to have the “illness” of “internalized superiority” (http://tinyurl.com/llldq3y).

Tip of the Month: Physicians who previously were in Medicare (and thus in PECOS), who opt out, can order and refer services. For those who have opted out and are not in PECOS, an NPI and other information supplied to the carrier allow the physician to order and refer.

“We have to take away from humans in the long run their reproductive autonomy as the only way to guarantee the advancement of mankind.” Francis Crick

“Frankly I had thought that at the time Roe was decided, there was concern about population growth and particularly growth in populations that we don’t want to have too many of.” Ruth Bader Ginsburg

Correspondence

Pay for Compliance. According to an article in the Wall Street Journal, insurance companies are paying oncologists $350 per patient per month for strict adherence to treatment protocols—which are geared to cost containment. It is very predictable. ObamaCare forces physicians into accountable care organizations (ACOs), and then strict cost-containment protocols are implemented. In the realm of cancer care, these are death panels.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY

Health Care Is Like _____. We spend about twice as much as other developed countries as a fraction of national output. Yet our results are mediocre. Public and private spending is growing much faster than our income―putting us on a course that is clearly unsustainable. It appears we are buying quantity instead of value. Outcomes vary wildly from state to state. And programs that target the poor seem to be backfiring instead. I’m talking about our system of higher education. U.S. spending is 3.1% of GDP, compared with the OECD average of 1.5%. And our results are far from the top. Over the last three decades, fees at public universities have increased 250%, compared with a 16% increase in family income. In 1964, federal student aid was $231 million; now taxpayers guarantee $1 trillion in student loans. Where is all the money going? (http://tinyurl.com/pa4bmjd)
John Goodman, Ph.D., Dallas, TX

2 + 2 = 5 Is Like _____. Calling me a homophobe because I believe that marriage is between a man and a woman is ridiculous. This tactic comes straight from Rules For Radicals by Saul Alinsky, the original radical community organizer and societal change agent, who said you should never have a rational discussion with your opponent. Doing so would humanize him, and your goal is to demonize him. If you can get him to respond angrily, and often irrationally, you can use the irrational response against him.

I don’t think I can impose my will on two consenting adults . They can do what they want to do. I’m not going to try to stop them, but they don’t get to change the definition of a societal pillar that has been there for thousands of years. It’s as if a new group of mathematicians comes along, and they say that 2 + 2 = 5. Traditionalists say, “No, it’s 4, it’s always been 4, it always will be 4.” And the new ones say, “No, we insist that it’s 5.” So the traditionalists say, “I’ll tell you what, for you it can be 5; we’re keeping it as 4.” And then the new ones say, “No, no, it has to be 5 for you, and if it’s not, you’re a mathosaur or mathophobe” (http://tinyurl.com/k6knfyt).
[excerpted quotations] Ben Carson, M.D.

Disintermediation. The internet has been the biggest force for providing people direct access to products, services, or information that previously required a middleman. Examples include Dell Computers, amazon, ITunes, and travel services. With Medicare and third-party payment, however, intermediaries between patient and physician have proliferated, draining at least 40% off the top of medical spending. They create complex regulations creating the need for million-dollar administrators. Since 1970, administrators’ salaries have increased 2,500%, while physicians’ payments have stagnated. The only way to restore medicine is disintermediation, placing the patient back at the center of all medical transactions.
Stanley Feld, M.D., Dallas, TX

“Bonus Opportunity.” Proposed “modernization” of Medicare, which would replace payment cuts for allegedly doing too many services to pay cuts for ordering too many services, is a change to corporate bedside gatekeeping. The incentive for profiteering is cloaked in pay-for-whatever (performance, value, efficiency, coordination, meaningful use of electronic records) eloquence.
Robert Geist, M.D., St. Paul, MN

Outcome-Based Education. Bill and Melinda Gates are pouring hundreds of millions of dollars into UN Agenda 21 Core Curriculum, which is intended to “radically change” traditional education. Religion is taken out of schools, home schooling is forbidden, and parents are replaced by techno-bots. Disguised as an “improvement,” it has the hidden agenda to dumb down education. According to EdWatch.org (http://tinyurl.com/k7lpwfq), the outcome to be “assessed” (not “tested”) is attitudes and behavior. For example, more than 60% of ninth graders believe government has a responsibility to decrease income differences. Even mathematics is claimed to be arbitrary and man-made.
Michael Riesberg, M.D., Pensacola, FL

Alinsky Lives. Though Saul Alinsky died about 43 years ago, his ideas live on. Hillary Clinton did her college thesis on his writings, and Obama writes about him in his books.
Samuel Nigro, M.D., Cleveland Heights, OH

Disappearing E-mails. The IRS is not the first to “lose” e-mails. In 2001, just after Judge Royce Lamberth ordered EPA to preserve all files relevant to a Freedom of Information Act request by Landmark Legal Foundation, Administrator Carol Browner asked a technician to wipe her hard drive. EPA was held in contempt; no one went to prison (http://tinyurl.com/lnb5qaz).
Jim Vanne, Aurora, IL

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