Protection of Conscience Project Library
Service, not Servitude
Extract
On August 22, 1939, Adolf Hitler gave a secret speech to his top military advisers, outlining his plans for German settlement of Poland. The speech so shocked his audience that a copy was smuggled out to the British Embassy. What follows is the transcript, now in the files of the Foreign Office in London.
Acheson D. Hitler’s plans for genocide: a speech from 1939. Br Med J. 1996;313:1416.
Extract
I conclude that genocide is the final stage in a three stage deterioration in social relationships. . . . The resultant first stage of social deterioration is so common that few countries in the world can claim complete immunity from it. . . . The second stage involves sporadic, often cyclical, unplanned violence including shop smashing, looting, arson, and riots. . . . The final and dreadful step, which leads to attempted genocide, involves a crucial additional factor. This is the active participation, either openly or in secret, of the state itself. . . .The mass media are often a crucial factor, manipulated by politicians to inflame public opinion by, for example, fanning tribal memories of long past victories and defeats. But we must not make the mistake of placing all the blame on politicians, for no act of genocide-whether in Auschwitz or Srebrenica-has taken place without a substantial measure of public consent.
Acheson D. Preventing Genocide: Episodes must be exposed, documented, and punished. Br Med J. 1996;313(7070):1415-1417.
Abstract
Fifty years after the Nuremberg medical trial there remain many unanswered questions about the role of the German medical profession during the Third Reich. Other than the question of human experimentation, important ethical challenges arising from medicine in Nazi Germany which have continuing relevance were not addressed at Nuremberg. The underlying moral question is that of the exercise of professional power and its impact on vulnerable people seeking medical care. Sensitisation to the obligations of professional power may be achieved by an annual commemoration and lament to the memory of the victims of medical abuse which would serve as a recurring reminder of the physician’s vulnerability and fallibility.
Seidelman WE. Nuremberg lamentation: for the forgotten victims of medical science. Br Med J. 1996 Dec 7;313(7070):1463-1467.
Abstract
Though the Nuremberg medical trial was a United States military tribunal, British forensic pathologists supplied extensive evidence for the trial. The BMJ had a correspondent at the trial, and he endorsed a utilitarian legitimation of clinical experiments, justifying the medical research carried out under Nazism as of long term scientific benefit despite the human costs. The British supported an international medical commission to evaluate the ethics and scientific quality of German research. Medical opinions differed over whether German medical atrocities should be given publicity or treated in confidence. The BMJ’s correspondent warned against medical researchers being taken over by a totalitarian state, and these arguments were used to oppose the NHS and any state control over medical research.
Weindling P. Human guinea pigs and the ethics of experimentation: the BMJ’s correspondent at the Nuremberg medical trial. Br Med J. 1996 Dec 07;313(7070):1467-1470.
Abstract
Defense attorneys at the Nuremberg Medical Trial argued that no ethical difference existed between experiments in Nazi Concentration camps and research in U.S. prisons. Investigations that had taken place in an Illinois prison became an early focus of this argument. Andrew C. Ivy, MD, whom the American Medical Association had selected as a consultant to the Nuremeberg prosecutors, responded to courtroom crticisim of research in his home state by encouraging the Illinois governor to establish a committee to evaluate prison research. The governor names a committee and accepted Ivy’s offer to chair the panel. Late in the trial, Ivy testified – drawing on the authority of this committee – that research on Us prisoners was ethically ideal. However, the governor’s committee had never met. After the trial’s conclusion, the report was published in JAMA, where it became a source of support for experimentation on prisoners.
Harkness J. Nuremberg and the Issue of Wartime Experiments on US Prisoners: The Green Committee. JAMA. 1996;276(20):1672–1675. doi:10.1001/jama.1996.03540200058032
Abstract
Conscientious objection preserves the personal integrity and wholeness of a health care professional’s character and personality. Professionals are obligated not only to codes of ethics and standards of care that guide their practices, but also to personal values. When professional and personal values conflict with health care delivery, nurses are compelled to object on moral grounds on behalf of themselves and the public they serve.
Baker TP. Descriptive and Normative Ethics: Conscientious Objection. Nurs Manag. (Harrow). 1996;27(10):32DD-32FF
Abstract
An Alberta woman recently won a lawsuit against the government of Alberta for wrongful sterilization that took place when she was a 14-year-old ward at the Provincial Training School for Mental Defectives. It was the first time the province has been held accountable for actions taken under the Sexual Sterilization Act, a 1927 law that promoted the theory of eugenics and led to the sterilization of more than 2800 people. It has since been repealed. A physician who served on the province’s Eugenics Board said the decisions were based on the best scientific advice and medical techniques available at the time. Today, she added, eugenics is being practised in a different way through prenatal diagnosis and therapeutic abortion..
Cairney R. “Democracy was never intended for degenerates”: Alberta’s flirtation with eugenics comes back to haunt it. Can. Med. Assoc. J.. 1996;155(6):789-792.
Abstract
The powers of medicine, as well as the faith put into it, endows the doctor a particular place within our social organisation. Possessor of its knowledge on the actions on the bodies, its power interferes with that of the society elites which imposes limits as well as obligations to profit the search of individual and collective well being. The doctor, magician or therapist, incites fear from the moment he attributes his powers only on the basis of his knowledge. We therefore have to consider him on the same level as the rest of society and while recognizing the special role of his profession, make sure that he is aware that he is not above the law, that he is linked to each of his patients due to the trust that they place in him. But this contract between two individuals is as well, and increasingly a social contract which places the medical practice in the complex game of social relations, even if at times it is seen on a more economic level. And that is why it is important to insert another social limit that would remind the doctor that his interventions affect the human body, and therefore the respect of a person and her identity and integrity. A medical science that is too proud or paternalistic, cannot keep to itself the mastery of new biomedical technology. It must be shared with his patients who now have a new role in healthcare, as holders of subjective rights. Should not the new “drama” of medical science, rather than imposing limits on some promoters of “promethenne” médecine, be that of reinforcing the obligations doctors have in general to serve their purpose towards social, collective and individual means that so often don’t inspire the trust that should be linked to conscience? Slave of a collective healthcare system, the doctor should still feel useful if his freedom to serve those that he helps is preserved. This does not necessarily mean that his participation in establishing certain social norms is impossible, however, it requires a definition of those issues that are relevant to the medical function. This search towards equilibrium, however ambiguous, and some even say impossible, appears to be even more acute in the sphere of biomedical practices. The monopoly conserved—and even reinforced—of the physician to protect the individuals at the beginning or at the end of their life, is added to a doctor’s burden, to a certain extent, of the weight of all the individual’s desires, of contradictory interests, and desire to do all that is possible in a world with real limitation. We therefore have to admit that his conscience can allow him to decline care to the patients that require it when he cannot or does not want to change their wishes. But even by acting this way, and that is why the clause of conscience distinguishes itself from contractual liberty, the doctor who refuses the administration of care must continue to have compassion towards his patients. So we can now wager, based on what we have just stated, that the medical practice will be a contributing factor in making law conform to the role that Aguesseau wanted for justice: “Juger humainement des choses humaines”.
Byk C. Médecine et droit: le devoir de conscience. Revue Generale de Droit. 1996;27(323-348.
Journal summary
With physicians in Canada under increasing threat of malpractice litigation, it has been suggested that adopting clinical practice guidelines (CPGs) as standards of care would free doctors from the fear of litigation initiated by dissatisfied patients. However, ethicist Eike-Henner Kluge argues that CPGs can only be considered general indicators of standards of care.
Kluge E-H. Clinical Practice Guidelines and the Law. Can Med Assoc J. 1996;155(5):574-576.
Extract
This article considers the problem of line-drawing between autonomy-preserving and autonomy-negating influence in clinical relationships. The author’s purpose is not to propose particular boundaries, either with respect to reproductive decisions by HIV-infected women or for other clinical choices. Rather, he attempts to shed some light on what drives our disputes about whether one or another influence method is compatible with autonomous choice. The author argues that such disagreements reflect underlying conflicts between normative commitments, and that resolving these conflicts is essential to settling controversies over whether particular influences unduly interfere with autonomous choice.
Bloche MG. Beyond autonomy: coercion and morality in clinical relationships. Health Matrix J Law Med 1996;6(2):229-304.