At Least My Patients Gave Consent

What would you think if you found out that I was doing experiments on some of my patients, without their consent, after they had lapsed into comas?

If that were true, you would be quite justified in demanding my arrest, even my execution. But unbelievably, that is exactly what your federal government--in the form of the Food and Drug Administration--now says is permissible, according to little-noticed new regulations that took effect in November. The regulations--otherwise undefined--permit using experimental treatment on patients in hospital emergency situations, without the patients’ consent.

Talk about hypocrisy! Never mind that such experiments are, the bureaucrats say, limited to “emergency and life-threatening” situations. What we have just taken is a fast ride down the slippery slope, right to the absolute depths.

Half a century ago, the “civilized” world self-righteously hanged seven German physicians for “crimes against humanity” in the form of medical experiments on helpless human beings.

That done, we piously concocted the Nuremberg code to ensure that such atrocities would never be repeated. So what do we have now? The FDA cheerfully sanctioning such experimentation through new guidelines that without any doubt would shamelessly violate the Nuremberg code. Dr. Robert Veatch, bioethicist at Georgetown University, called it right: Noting that 1996 was the 50th anniversary of the trial of major Nazi war criminals, he observed, “We are commemorating that event by adopting regulations that flat-out are in violation of the Nuremberg code.”

Why this travesty? I doubt that it is ignorance or even malice. The problem lies in ethical anomie, philosophical befuddlement and the hypocrisy that today permeates every aspect of our so-called civilized world. Just as once “immoral and illegal” lotteries quickly became both moral and legal when states faced financial crises, so previously immoral and illegal experimentation is suddenly about to become sanctioned now that medical science faces a little-known research crisis.

After all, such experiments are the only way to get certain desired medical data on humans, and if we can’t get informed consent from the patients (really, victims) we can easily justify it by saying the work is for the benefaction of the rest of humanity. Doubtless the seven German physicians who were hanged after the war had felt the same way.

What makes the FDA regulations even more repugnant is that there is a completely moral, honorable and even legal way to carry out such experiments. How? Two sets of circumstances. The first involves people sentenced to death. From interviews I have conducted, I know that some inmates on Death Row would, if given the option, choose to be rendered unconscious by deep surgical anesthesia induced at the time set for execution, after which physicians would conduct hitherto impossible research, from which the subject would never regain consciousness.

Where’s the immorality here? The condemned chooses freely, is permitted to recant, signs consent forms, owes society a debt and eventually dies having done at least a tiny bit with as much dignity as that accorded patients in hospital operating rooms each day. Isn’t that better than mere sterile vengeance?

The second group of patients are those who are condemned by agonizing disease or injury and who choose to end their suffering through what I now prefer to call patholysis (from the Greek for ultimate eradication of suffering) but which is more commonly known as physician-assisted suicide.

Again, from my extensive experience I can assure you that a significant number of these patients are eager to submit to such experimentation under the circumstances described above. Many are eager to donate organs to help save other lives.

Either course would be a tremendous plus for humanity--and in total accord with the Nuremberg code.

Radical as this may sound, the FDA, by issuing its hypocritical guidelines, is guilty, under the Nuremberg code, of conspiracy to commit crimes against humanity. Should American physicians act on those guidelines, they will be as guilty of crimes against humanity as the German doctors were judged to be half a century ago.