Extract . . . For people with genuine morals, right and wrong do not change with popular public opinion . . . Before we congratulate our society on its social evolution over the last 50 years, we should reflect on the outcome of the society in history that practised throwing people to the lions, or perhaps the society of the 1940s that practised execution of races believed to be inferior.
[Dr. Waugh planned to respond to these letters but was unable to do so before his death on Apr. 18, 1997. In this issue, CMAJ features a tribute to Waugh (page 1524) as well as an article on issues surrounding access to abortion services (page 1545). — Ed.].
Extract When I was a medical student in the early ‘40s, and for a considerable time after that, the artificial termination of pregnancy was considered an unspeakable crime. . . . No one knew for certain how widespread the practice was, but enough patients turned up in emergency departments or in the morgue for us to know it was going on, and to arouse the ire and indignation of society’s moralists. . . . The credit for bringing the revolution about certainly belongs to Dr. Henry Morgentaler, but it is clear that Canada’s social climate had been changing slowly for several years before he defied the law by opening his first abortion clinic in Montreal . . . True, the anti-abortion campaign is not yet dead, but its force has become so attenuated the impact is limited.
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.
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.
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.
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.
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..
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.
Abstract I propose that a woman who becomes pregnant with the intent to abort will be treated as an initial aggressor, and as such she will be denied the “abortion exception” that will be granted to the woman who aborts an accidental, unwanted pregnancy. Moreover, I shall argue that a woman should not be allowed to designate the donee of the fetal tissue from her abortion, even though her pregnancy was accidental. Without this restriction, a woman who intends to become pregnant and abort may simply claim her pregnancy was accidental, and thereby claim the exception. Central to this study is the question of fetal worth, and the value to be ascribed to beings not like us, that is, not like human beings who have been born. Although I argue for a moral justification of elective abortions, I intend to show that such a justification should be a narrowly drawn exception to the prima facie duties neither to harm nor to instrumentalize others. I shall also argue that prohibiting a woman from becoming pregnant in order to abort is necessary because such a situation does not fall within the narrow exception for elective abortions, and that such a restriction is crucial to preserving our respect for those with no voice. Finally, I shall argue that the prohibition against becoming pregnant with the intent to abort does not vitiate a woman’s right to terminate an unwanted pregnancy. Rather, this restriction is a necessary condition of the prima facie duties of nonmaleficence and non-insturmentalization.
