Informed Consent and Autonomy

It wasn’t on my list to write a post about informed consent and the ethical principle of autonomy. A few days ago, I posted to Twitter about informed consent and the post went viral. It seems increasingly important for people to understand their rights in this current climate.

I studied a Masters in Medical Ethics and Law and wrote my thesis in 2006 on whether you can truly give informed consent and exercise autonomy in an emergency situation. To discuss this question, I had to dig deep into how ethical principles apply. Let’s see where we stand today, in 2021.

Ethical Principles in Medicine

Clinical ethics is the application of ethical theories, principles, rules, and guidelines to clinical situations in medicine. The most common approach to clinical ethical analysis is Principlism. Principlism is a set of principles aimed to guide medical practice, from simple clinical situations, to more complex ones.

According to Principlism, the medical practitioner must attempt to uphold four important principles.

Respect for patient autonomy, beneficence, non- maleficence, and justice. If their principles are in conflict, resolving them depends on the details of the individual case.

How can it be applied?

A 32 year old man who has been in a car accident. Ventilated and sedated, he needs to have a limb amputation as an emergency. He is unable to consent as he lacks capacity, in a medically induced coma and cannot exercise his autonomy.

Ethically in this scenario, a doctor must act in the patient’s best interests (beneficence) and do no harm (non maleficience). To understand a patient’s best interests it is important for doctors and nurses to be able to talk to family and friends, and understand a picture of the patient’s life pre admission.

The doctor should also consider the wider aspect of justice, which is fair and equitable treatment in addition to distributive justice. Distributive justice considers the wider community and aspects. This may come into play when ICU beds are at a limited resource, for example.

Ethics and Covid 19

These principles are being impacted by measures imposed due to the declared pandemic. Where do they fit within these pillars? When discussing ethics, it is a good idea to use the Socratic method of analysis.

The Socratic Method (named after Socrates 470-399 BC) is a dialectical method of inquiry that uses questions to clarify and unpack one’s beliefs, to understand the assumptions, evidence and reasons used to support them, and to expose any contradictions, inconsistencies and fallacies in one’s thinking.

Have the rules and regulations because of Covid measures affected the way in which a doctor or nurse can ethically practice? And have they impacted the way in which we are able to exercise our own autonomy, to the point where informed voluntary consent is impossible in this climate?

Codes of Conduct

Healthcare professionals come from all types of cultures and moral backgrounds. Doctors are registered with the General Medical Council, and nurses with the Nursing and Midwifery Council in order to practice.

The GMC and NMC have codes of ethical conduct, to act outside of this means they could lose their registration to practice. In addition they risk facing criminal charges if they act outside their code and the law.

In the late 1970s the rise of biomedical ethics inaugurated a large flurry of publishing on the subject. Suddenly recognizing the individual as the pivotal decision maker. Respecting each person’s interest in self-determination, became understood as the primary moral issues in medical ethics.

Respecting a patient’s right to autonomy and self determination is paramount. If a person is unable to exercise their autonomy, health professionals should act in patient’s best interests, and above all, do no harm.

Why are ethical principles important?

Individuals have a right to the care and treatment they deserve, based on these principles. The four basic principles serve as the basis for ethics in the medical profession.

These principles have guided medical professionals for years. Based on current actions of our Governments, selected experts and the controlled media, it is becoming increasingly difficult to have your rights protected.

In order to keep their jobs, carers and nurses working in nursing homes are being forced to take a vaccine. This I believe, is a coercive factor, and coercion invalidates voluntary consent. How can nurses promote bodily autonomy for their patient’s, when their own autonomy is not being respected? It also does not comply with employment law.

What is the Gillick Competence?

Gillick competence maybe something you have only recently heard of, but it has been applied since 1984. It was ruled that a child of under 16 may not need parental consent for certain interventions or treatments. They may voluntarily consent to the procedure if deemed competent, but must be fully informed of the risks and benefits, as would be the case with any competent adult.

Teenagers are being told they may be able to consent to take the Covid vaccine, without prior consent from their parents or guardians. Some might even say encouraged or pressured.

Certain Universities are requiring vaccination to undertake courses. Is this ethical or is it again a coercive factor? Teenagers and children have very little risk of the disease itself, with an increased risk in adverse effects from the vaccine.

It could be argued that these vaccines are still under their trial period, therefore “experimental”, and Gillick should not apply. Gillick competence should also be individually assessed, not blanket applied. How the process of applying Gillick will occur in schools is unclear.

Bell vs Tavistock and Portman NHS Foundation Trust set a further precedent. This highly publicized judgement was the result of a legal complaint first lodged against the NHS Gender Identity Development Service (GIDS) in 2019. It was ruled advice around hormone therapy was “potentially misleading,” and that true “informed consent” could not be given under such circumstances.

Have teenagers been properly informed of their overall risk of Covid itself versus the vaccine? Are they being misled, and can they give consent even if deemed Gillick competent?

Is there long-term data on the vaccines, or up-to-date disclosure of true efficacy? No. Were the trials full of bias? Yes. The whole process is undermined by disclosure.

Are we getting true unbiased information? Can anybody really give true voluntary consent, let alone teenagers who are desperate to “get back to normal”?

Medical Apartheid

To attend certain events people are having to test to prove they don’t have this new virus from which they have no symptoms, or show proof of vaccination. This is despite the fact you can still catch and transmit the virus once vaccinated.

We are seeing this happening in France and other countries around the world. We have entered a dangerous vacuum of medical apartheid where coercion, bias, judgement and shaming have replaced respect for autonomy. Where does it end?

The importance of autonomy rose to prominence during The Enlightenment, when thinkers like Immanuel Kant started to see it as the defining characteristic of humanity.

Kant believed, human beings’ autonomous nature was the basis for all morality – if we weren’t autonomous, we couldn’t be held responsible for anything we did. If that were true, there’d be no point for ethics. Immanuel Kant would be turning in his grave.

And here we are.

NHS: Free at the point of care

The ethos of the NHS is to be “free at the point of care”. This does not mean in monetary terms, but free from judgement and restrictions on accessing care. There has been talk, by people in the health care profession, that those that are not choosing to vaccinate should not be able to access care.

Refusal to test, is leading to refusal of entry to many hospitals. The number one contributing factor to dying from Covid 19 is obesity. Should NHS care be refused for those who do not take care of their own metabolic health? Where does it end?

Care should be free and equitable to all. For someone who always championed patient choice and informed consent, seeing autonomy slip to the bottom on the list is very concerning.

Suddenly we have gone from protecting the patient’s autonomy, to moving to a “greater good” argument of public health and community. But what if the measures were not in the “greater good” at all? NHS waiting lists have increased to 5.4 million due to restrictions on accessing care in the community and hospitals for starters.

Slippery slope?

We have gone from a slippery slope argument to a jumping head first off a cliff argument. The lack of ethical and legal debate has been shocking. Years of hard work in championing patient’s rights have been undone. This is not a blame game, but trying to understand where things have gone wrong, and why we should be concerned.

Slippery slope arguments work by suggesting that if you permit, or accept “this”, then inevitably, by a series of small and perhaps seemingly innocuous steps, you will end up somewhere everyone would accept is very bad.

Slippery Slopes – Health Ethics

There are hundreds of thousands of nurses and doctors who are honest and hard working. These restrictions have come from top down, where staff working on the ground have very little say in policies that may affect their patients. However, doctors and nurses need to ask themselves, if the current measures they are working within, allow them to fulfll their ethical codes and what they should do about it.

Consultants and Ward Sisters no longer have full control over what happens on their units and departments. Care is crushed by audits, patient pathways and targets. In a time where hospital acquired infections are a huge problem, the art and practice of nursing and medicine has become sterile, yet infections remain.

As a nurse or doctor working in the health service, you believe that regulatory bodies and experts will use an extensive evidence base. The best evidence. You believe that all pharma meds have been properly trialled and researched and safety standards are tight. What we see regarding Covid 19 has flipped this on its head. Conflicts of interests loom large.

At what cost?

Patients have died alone without support from their loved ones due to restrictions in visiting in Nursing Homes and Hospitals. Residents in nursing homes have barely any human contact, besides staff, for months on end. Loneliness, stress, fear and anxiety, all lower life span. Prescriptions given to teenagers for antidepressants have risen considerably. Access to mental health support is becoming more and more difficult.

Relatives and friends are advocates for patients, yet they have been restricted or prevented from seeing their family at their most vulnerable time. All of this is based on scanty evidence that asymptomatic spread is the driver of a pandemic, and those with no symptoms are a risk to others.

People with no symptoms, do not have something called a viral load. PCR testing has been run at well over recommended thresholds, questioning the validity of the result of millions of tests. Billions of people have had periods of restricted movement. Many countries still have masked mandates outside, despite a lack of evidence to say it makes any difference and may indeed cause more harm.

Even Fauci said that asymptomatic people are not a driver of a pandemic, before Pharma took over the strings. We go back again, to do no harm. Has harm has been caused by these measures?

Access to medical treatment

Many people have been unable to access their GP for face to face appointments for over 18 months. People have been so terrified due to media/ social media, government and “experts” fear driven messages, that they avoided hospitals.

Problems do not get resolved and conditions worsen. Deaths at home have rocketed. Nursing Home deaths still have not been properly addressed. Billions have been spent on track and trace, building of the Nightingale Hospitals and vaccination roll out. Is that fair when we talk about distributive justice? Would those funds have been better directed for example to mass testing of adequate Vtamin D levels and supplementation, for example? Why have all resources been funneled into one area?

Lack of open debate

There has yet to be an open debate about the impact of lockdown itself and on going measures. Worldwide people were told that lockdown would save lives, protect the NHS and the vulnerable.

It has done none of those things, and it still looks like we could head for more lockdowns in the future. The impact of the measures will continue for years.

While the NHS has had periods of intense pressure, particularly on ICU beds, the Government and NHS have had more than 18 months to prepare for this winter. This summer, despite vaccinating a vast number of the population, has seen a rise in cases and deaths. This is unusual for the summer period and a so called respiratory illness.

No society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means

Aneurin Bevan, founder of the UK NHS.

Let’s see how this applies in more depth regarding the current scenario. First, let’s talk more about autonomy.

Autonomy

What does autonomy actually mean?

The first and overriding principle in life and medical ethics is autonomy. Autonomy and informed consent go hand in hand.

autonomy [aw-ton´o-me]

The ability to function in an independent fashion.

Self-determination, free from both controlling interference by others and personal limitations preventing meaningful choice. For example, inadequate understanding or faulty reasoning

Capacity to act with autonomy does not guarantee that a person will actually do so with full understanding and without external controlling influences.

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition

Autonomy means that a patient has the ultimate decision-making responsibility for their own treatment. Autonomy overlaps with the principle of informed voluntary consent.

…to be autonomous is to be one’s own person, to be directed by considerations, desires, conditions, and characteristics that are not simply imposed externally upon one, but are part of what can somehow be considered one’s authentic self

Christman 2015

A medical practitioner cannot impose treatment on an individual for whatever reason, except in cases where that individual is deemed to be unable to make autonomous decisions. See Mental Capacity Act and Emergency Doctrine.

The principle that a patient has the right to choose what happens to their body seems pretty straight-forward. It’s important to remember that historically this has not always been the case. Some patients defer all decision-making to the “wise Doctor”, even if they do not feel comfortable with their treatment plan.

To exercise your own autonomy you need to have the following conditions:

• Capacity to be able to understand treatment, risks and benefits
• In relation to consent to treatment, this means people are capable of understanding the nature, implications and consequences of their decisions
• A person is considered to have capacity to consent to treatment if they understand in simple language what the treatment is, its purpose and nature and why it is being proposed
• If capacity is in question due to various reasons, an assessment must be made
• Be free from “undue” influence, such as coercive factors or bias
• Have access to all information needed to exercise autonomy and give informed consent

Respect for autonomy can rightly be said to be the “first among equals”

Beauchamp and Childress  Principles of Biomedical Ethics

Beneficence

What is beneficence?

Beneficence means that all medical practitioners have a moral duty to promote the course of action that they believe is in the best interests or benefit of the patient.

The beneficence pillar of medical ethics is to “do good”. It is derived from the Latin word benefactum, meaning “good deed.”

The ethical pillar refers to the moral requirement of medical professionals to act in what they believe is their patients best interests at all times.

For example, doctors should be able to identify which available evidence-based treatment would give their patient the best outcome. Often, it’s simplified to mean that practitioners must do good for their patients, but thinking of it in such a simplistic way can be problematic.

Medical practitioners should think of beneficence as the process of ranking the available options for the patient from best to worst, taking into consideration the following aspects:

• Will this option resolve this patient’s medical problem?
• What is the proportionate to the scale of the medical problem?
• Whether is is compatible with this patient’s individual circumstances?
• Are outcomes in-line with the patient’s expectations of treatment?
• Be concerned with the patient’s expectations or circumstances. This is also known as holistic or patient-centric care
• Balance risk vs benefit
• Have no conflicts of interest

In the patient’s best interests.

It is important that medical practitioners bear the patient’s expectations in mind when ranking treatments because when we refer to doing “good” we are not simply referring to what is medically good for the patient, but also what is acceptable to the individual.

Beneficence is important because it ensures that healthcare professionals consider individual circumstances and remember that what is good for one patient may not necessarily be great for another.

All professionals have the foundational moral imperative of doing right. In the context of the professional-client relationship, the professional is obligated to, always and without exception, favor the well-being and interest of the client.

Frank Stuart Kinsinger 2010

Health care professionals have a duty of care that extends to the patient, professional colleagues, and to society as a whole. Any individual professional who neither understands nor accepts this duty is at risk for acting malevolently and violating the principle of honoring and protecting the patient.

Non- Maleficence

What is Non- Maleficence?

The principle of non-maleficence refers to the duty of doctors to avoid any treatment that is known as being useless or acting against the best interest’s of the patient. 

An example of a non-maleficent action is the decision of a doctor to end a course of treatment that is harmful to the patient.

The term non-maleficence means “to do no harm” and is an ethical principle that often opposes beneficence, which involves considering the benefits of a certain treatment and balancing them against any possible side effects that may occur.

The ethical principles of beneficence and non-maleficence derive from the paternalistic type of doctor-patient relationship that only started to change in the 20th century by giving more autonomy to the patient. In 2021, are we going backwards?

Above all, do no harm

Non-maleficence means avoiding the causation of harm. As many treatments involve some degree of harm, the principle of non-maleficence would imply that the harm should not be disproportionate to the benefit of the treatment. 

Non-maleficence differs from beneficence in two major ways. First of all, it acts as a threshold for treatment. If a treatment causes more harm than good, then it should not be considered. This is in contrast to beneficence, where we consider all valid treatment options and then rank them in order of preference.

Second, we tend to use beneficence in response to a specific situation – such as determining the best treatment for a patient. In contrast, non-maleficence is a constant in clinical practice.

The Hippocratic Oath – Do No Harm used to be the first and most important rule for any Medical Doctor, Nurse Or Health Practitioner. A promise that doctors and healthcare practitioners will decline from doing harm to their patients.

Justice

What is Justice?

The ethical principle of justice is the foundation for other very valuable healthcare concepts like fairness and equality. Justice should be evident whenever persons are due benefits from others because of their particular circumstance, as when they are ill or when they are struggling emotionally.

The fulfilment of this principle is based upon the professional’s respect for the fair and equal distribution of services regardless of societal differences like race, status, religious orientation, or health care choices.

Treating equals as equals and unequals as unequals lies at the heart of the principle of justice. In a democratic society we begin with the assumption that there is a basic equality which runs through the population.

Ethical mandates based upon this assumption is that equals are to be treated equally. If a right is recognized, e.g., the right to self-determination, then each person should be able to act on such a right. This cannot be arbitrarily given to some and not to others.

Individuals are not equal in every respect. Sometimes they are unequal. They are unequal because there is some characteristic which counts as a morally relevant difference between them. Has this principle been protected?

Distributive Justice

The allocation of benefits and burdens is the heart of the distributive version of the principle of justice. In distributive justice there is an identification of the goods or benefits which should be available to individuals in society.

The principle requires that the benefits be available to all in some equitable way. This principle also requires that the burdens, e.g. cost, for providing these benefits should also be distributed in an equitable manner across the population.

No one person or group of persons should bear a substantially greater burden than another. The application of this principle lies at the heart of the healthcare reform movement. Initially, there is a determination that some measure of healthcare is a benefit which should be enjoyed by everyone.

On the surface it would seem that healthcare professionals acting in a clinical setting should not have to worry about the principle of distributive justice. This seems to be a social policy matter. But as a practical matter distributive justice often becomes an issue.

Issues arise when questions are asked about whether a particular approach to treatment is cost worthy. Particularly when someone besides the patient is paying the cost. For example, whether a patient is a good candidate for an ICU bed.

Another example, whether to charge higher prices to those patients who can afford to pay in order to compensate for those who cannot afford to pay. The debate about distributive justice in healthcare is an ongoing one.

Once healthcare is no longer a commodity in the free market where the patient simply “gets what she pays for,” distributive justice becomes the central issue. Healthcare reform will not solve the problem of its application. It will merely shift the focus and inflame the debate.

How does this relate to informed consent and the Covid 19 vaccine?

I am not going to go into whether you should have the Covid vaccine or not. That is an individual decision and should be based on health care need, after considering all the information. Your right to choose to have it, is the same as your right to refuse.

I will say though, taking a vaccine or any medical treatment, should never be to travel, to be able to buy food or for fear of missing out. I will discuss if the current climate we are in allows a situation where you can give true informed voluntary consent and the reasons why I have that opinion.

Think about all the ethical factors at play. Apply it to what you have witnessed in the last 18 months in your own reality and whether these pillars have been affected by measures imposed.

Voluntary Consent

Informed consent is important: in research, it allows subjects to make an informed and voluntary choice to participate–or refuse to participate–in a project where they will be asked to take risks for the benefit of others. In both research and clinical care, informed consent represents a permission to intervene on a person’s private sphere. 

Cahana & Hurst 2008

Informed voluntary consent factors around the ability for an individual to assert their own autonomy, in either research or clinical care.

The elements of informed consent are described as:

• disclosure
• understanding
• decision-making capacity
• voluntariness

Each poses distinct difficulties and can be amenable to improvements.

Aside from the fact that many of the Covid vaccine trials do not finish until 2023, I am going to look at this from a clinical perspective of the process of gaining consent. You can access the Pfizer protocol here for more information on how the trials have been conducted.

Disclosure

The first point which may lead to a situation where informed voluntary consent is affected, is regarding disclosure. This means for example, have all risk vs benefits been disclosed to a patient before they decide on a course of treatment or intervention?

This principle is also cemented in a legal ruling, Montgomery v Lanarkshire Health Board [2015].  The ruling established that, rather than information and risk being a matter for clinical judgment to be assessed by professional medical opinion, a patient should be told whatever they want to know. Not what the doctor thinks they should be told.

This is particularly relevant when discussing the vaccine, we are told for example that it is safe and effective and thoroughly tested. But what one person considers safe, another might consider too much of a risk. Are all risks being disclosed?

Here is the latest MHRA Yellow Card Reporting figures, and the PHE figures on vaccinated/ unvaccinated cases and deaths in Scotland. Have a look and make your own mind up. Is this being openly disclosed? Are the numbers being presented in a fair and unbiased fashion?

Are the numbers accurate?

There are several reasons why the numbers might not reflect the true cases of Covid 19.

Deaths are being recorded as Covid if the patient died of something else, within 28 days of a positive test. So you could die of terminal cancer, but had a positive asymptomatic Covid test 27 days earlier, they will record you as a Covid death.

Most of the registered PCR-positive SARS-CoV-2 associated deaths have significant co-morbidities (an average of 2.6 co-morbidities per associated death, as reported by the CDC). Subsequently, recorded UK deaths with SARS-CoV-2 are deaths within 28 days of a positive PCR test. Therefore, there is no certainty that these deaths were caused by SARS-CoV-2 or COVID-19.

In 2020 the CDC announced only 6% of cases had no underlying co-morbidities and only had Covid as a sole cause of death on the certificate. The same has been reflected in other countries.

This leads to a situation where anybody trying to make a decision based on risk versus benefit, will find it difficult. If we do not have a good accurate number of true deaths associated with Covid 19, how can we ever balance that risk?

This matters because it impacts on the overall infection fatality rate and case fatality rate. The rates are changing all the time, as is the number of cases admitted to hospital and deaths. But are we openly been told the good news that overall case fatality rate is less than seasonal flu?

The butterfly effect

Post mortems were seldom undertaken to determine the true cause of deaths due to restrictions advised under the regulations of the pandemic. This suprised me as pathologists deal with infectious diseases all the time and doesn’t normally mean post mortems would be stopped. Has this affected the way we really understand the pathophysiology of the disease Covid 19?

Reports of families saying their loved ones died of something else but were recorded as Covid deaths have surfaced. If this is the case, and we do not have accurate figures, how can we ever know the true mortality rate of Covid 19 and therefore make an informed choice of the risk benefit of the vaccine?

The media, governments and hand- picked medical experts have misled the public about true case numbers and severity. They have framed the numbers with political bias and they have misled the general public.

An exposure of their fear-mongering activities is presented in the excellent book

‘A State of Fear’’ by author, journalist and photographer Laura Dodsworth.

I am not denying that people become very sick with Covid 19 and can end up in ICU or dying. But the fact remains that most don’t. For most people Covid 19 is a mild illness, in fact up to 85% of cases were classed as “asymptomatic”. Meaning they had no symptoms. Cases are considered a cases just on the basis of the positive PCR test.

Numbers are important, as is an understanding of the butterfly effect. Unless we learn from history, we are doomed to repeat it. With repeated lockdowns happening in other countries even during summer, we should expect the threat of further lockdowns again in winter. Were the original lockdowns ever in the best interests of society as a whole?

Covid 19 is not a death sentence

It is obvious reading social media and talking with people that some believe Covid 19 is automatically a death sentence. As a result, people have been terrified. Truth is, 99.9% of those under 60 with no underlying conditions survive. Risk varies, increasing with age and number of co-morbidities. This calculator based on 2020 figures can give you an idea of your underlying risk.

Obesity, diabetes and hypertension are common co-morbidities, very few people have died of Covid 19 without any “known” underlying conditions. Mortality Risk of COVID-19 – Statistics and Research – Our World in Data

Those with co-morbidities should discuss with their doctor about need for vaccination especially after having had Covid 19. There is evidence you have long standing immunity from natural infection and may not need the vaccine at all.

The need for boosters if you already took 2 vaccines should also be discussed with your health care provider. However, ultimately the decision lies with you, the individual. Your body, your choice. Do not go into this blindly.

When people ask me if they should take the vaccine, I advise if they have had Covid or symptoms of Covid in the last 18 months they get their antibodies checked as a first point of call. I also advise them to do their own independent research and ask questions.

It is important to remember that the vaccine does not stop you contracting nor transmitting the virus. It is said to only reduce your risk of Covid 19 severity, hospitalisation and death. You can still have a high enough viral load, despite being vaccinated if you are sick, and pass to someone else, vaccinated or not.

Every action has a reaction. It is unclear how many have died due to lockdowns, loneliness, depression, suicide, delayed treatment and the economic downturn. Poverty kills. Stress is damaging. Fear is not a healthy state to live in.

Can we honestly say that the lockdowns created more problems, misery and death than if the Sweden model had been adopted?

Have people been terrified by misreporting and failure to provide balance to a point they cannot give true informed voluntary consent?

Have all the trial details and subsequent adverse events been reported?

What is actually being disclosed to people who are about to receive a vaccine? Whilst some attempt at consent is happening in the vaccination centres and GP surgeries, is it enough?

Can experts, celebrities and regulatory bodies really declare that the vaccine is safe and effective? Has the trial been conducted in a manner that gives statistically important figures? Do we have any long term data? Have people been warned of something called antibody dependent enhancement?

The answer to all the above questions, is no. The information leaflets and numbers given out on the media is based upon date from the initial trial period. Those numbers are based upon infection rates 7 and 28 days post 2nd dose.

There is one glaringly obvious flaw in the trial, what if simply people had not been exposed to SARS CoV-2 during the period of 28 days post 2nd dose? That was the very basis the “95%” effective number came from.

The real time data is showing a much lower efficacy and worse safety profile than was established during the trials. There is no longer term data past 6 months. And there won’t be either, because they have now unblinded the trials.

There is no extenisve study to show that the vaccines are safe to take in pregnancy either. This is admitted in the FDA approval documents of the Pfizer vaccine. They don’t know. They think it is safe, but they don’t actually know. No baby who was born to a mother who had been vaccinated is over 12 months old yet. Therefore how can anyone declare it is totally “SAFE”?

Data from Israel is showing that the efficacy isn’t quite what they said either, and now they are rolling out 3rd “booster” jabs. Where does this end? 6 monthly boosters?

The Role of Social Media and Media

What has shocked me most about this pandemic and the coverage of it, is the lack of open debate. The only experts and celebrities that have been invited to talk on the news, have been from one perspective. The one that supports the narrative. There has been very little balance or sense, with the overwhelming energy of fear.

Figures have been produced and constantly rammed down our throats. There is a running death count on the news everytime you switch it on, or news of a new deadly variant. There has been a misundertanding of basic biology.

Years of research on herd immunity, how viruses work, the importance of your immune system and antibodies has literally been re-written to suit their narative. The virus wasn’t the end goal. The end goal was world wide mass vaccination and the introduction of vaccine passports. The next step? Is it a social credit system?

There is misinformation on all sides, but I have witnessed blatant lies being told on the BBC News, and news stations across the world. Reporting is full of bias, shame, blame and judgement. It does not culture a healthy environment where you can trust the information being shown. The propaganda machine is strong, with social media giving even more ways to brainwash and shame people into ways of thinking.

Social media has become a battle ground. Disinformation comes equally if not more from the side of the main stream media. It is no wonder everyone is confused by everything that is going on. There have been increasing levels of censorship on various platforms.

Experts that have a counter view have been struck off, shamed and discredited. Those questioning any measures have been slapped with a conspiracy label. Attacks for those with an opposing view are viscous and personal. Health care professionals are being gagged, whistle blowers are not able to speak freely.

There are many other areas where disclosure has been minimal, or facts and figures have been manipulated. What this leads to is an issue where it is impossible to consent due to selected disclosure, meaning people are deciding on false pretences.

Are there treatments available for Covid 19?

There has been constant censorship and refusal to acknowledge that for the Covid 19, there are interventions that can reduce severity and be used as treatments. There is a ever growing body of research that shows there are effective treatments for Covid 19, preventative and therapeutic, in addition to standard hospital treatments and protocols.

See evidence of Hydroxychloroquine, Ivermectin, Vitamin D, Vitamin C, Melatonin, Monoclonal antibodies on each link.

Dr Zelenko Protocol for prevention and treatment early stage.

Frontline Covid Critical Care Alliance protocol. More information on I-Mask, I-Recover.

There is solid evidence Vitamin D levels and risk of admission to ICU and death are closely linked. It is not new science that Vitamin D levels are protective against respiratory winter viruses and your immune system. Yet, Matt Hancock openly said in the House of Commons that there was no evidence Vitamin D would be helpful. This is simply a lie and the importance of Vitamin D became a conspiracy overnight.

The prevention or treatments mentioned above are only a small example of what is being trialled and tested at the moment. The bottom line is, the best protection you have is your own metabolic and immune health. There are many ways in which you can do this. If you are not sure where to start, see here.

We have an immune system for a reason

The lack of promotion of metabolic health and ways in which you can protect your own innate immune system has been noticeably absent. Instead of telling us to get outside and be in the daylight, they locked us down and restricted time outdoors. Children’s parks were closed. They police taped off street benches. People were arrested for going for a walk or going to see isolated loved ones.

Instead of telling us to stay calm, focused and have faith, they told us if we hugged our grandmothers, we would kill them. They made children believe they are walking viral vectors and would be murderers. They made people cover their faces on the weak evidence masks slow spread.

Gyms and sport clubs were closed. They closed churches and pubs and other venues where people gather to be humans. They stopped children getting an education and placed an enormous amount of pressure on people.

Every narrative they have pushed suits their agenda. You don’t have to be conspiracy minded to feel in your soul that something isn’t right. That it is counter intuitive. If there really was a deadly pandemic that would kill us all, would they have to use behavioural manipulation techniques and bribes of free burgers to persuade people to take an experimental vaccine? Why were there more behavioural psychologists on SAGE than immunologists and virologists for example?

For all these reasons we can question if disclosure has been adequate to allow for a situation where informed consent can occur. I believe it hasn’t.

Understanding & Decision making capacity

Understanding in terms of informed consent can be complex. One person might be able to consent to a simple examination, but be unable to understand the consequences of more complex treatments.

In a basic sense, an individual should be able to understand the information being presented, and how that applies to their circumstances. They need to be able to balance risk versus benefits. They have to be able to process how this might impact on their lives. We are sovereign beings, who are entitled to decide for ourselves. Nobody can take that away from you.

There are many reasons why this might be in doubt. For example, under the influence of alcohol or drugs, moderate/severe learning difficulties, dementia etc. Essentially an individual should only ever take a medical treatment or intervention with the understanding that that course of action is in their own best interests.

Your body, your choice

Nobody should take a medical intervention to protect others, to keep others happy or to be able to exercise their freedom. People who have taken the vaccine because they have been told they will need it to travel have done the opposite of protecting our freedoms.

Essentially though, people’s ability to understand the situation we are in is based upon a number of factors. Education, IQ, level of common sense, life experience, expectations, how much independent research a person might do, for example.

As per their ethical codes mentioned earlier, doctors and nurses should do their upmost to ensure a patient’s understanding for treatment. If a patient is unable to understand due to lack of capacity, the health practitioner must act in the patient’s best interests.

Understanding, relies on disclosure of the true facts and numbers. And that is related to health practitioners themselves. Have they got true, unbiased information and acting without conflict of interests? Are they able to ensure true informed voluntary consent is given?

Voluntariness

Finally we come to the issue of voluntariness. Can you voluntarily consent to the Covid vaccine in these currrent times. I’d argue that it is unlikely. Why?

Everybody is exhausted with what is going on. People are always referring to “getting back to normal”. Life as we knew it, has been affected in many ways by the pandemic (not necessarily the virus itself), so much so, that people are desperate to do anything they can to get back to how things were. Some may argue that alone is a coercive factor.

That includes agreeing to a medical intervention under normal circumstances they might not feel they want or need. Taking a vaccine to be able to travel or to be able to attend a concert is not how medicine is supposed to work. You take a medical intervention based on need or risk.

People are being pushed out of jobs, told they cannot participate in day to day life if they are not vaccinated. They are being called selfish for not taking one for the team. This allows for an element of coercion and coercion invalidates voluntariness.

the use of express or implied threats of violence or reprisal (as discharge from employment) or other intimidating behavior that puts a person in immediate fear of the consequences in order to compel that person to act against his or her will

Coercion | Definition of Coercion by Merriam-Webster

The media is pushing a view that if you do not take the vaccine you are also being selfish. Friends are excluding other friends because they have not been vaccinated. What has happened to society based on a fear pushing agenda is heartbreaking. All of this leads to a condition, where the ability to give true informed consent is eroded.

In conclusion

Medical Ethics is not always clear cut, and involves complex discussions into individual cases. However, I am clear in my belief that what is happening now is so far removed from the pillars of ethics, that nobody is giving true voluntary informed consent. That goes against ethical code and precedents set in law.

Our Governments (all over the world) have conflicts of interests and are removing our civil liberties bit by bit. Easily it seems. There is no public consultation. We are being told to accept it and it is the only option we have. Once our basic freedoms go, they are very difficult to get back.

I do not care if you choose to take the vaccine or not, what I care about more is whether we are doing it in an informed, voluntary manner. I don’t believe we are. The purpose of this article is not to blame, shame or upset anyone. It is to try and understand if the situation we are living in is ethical. Did we decide that we would forfeit autonomy for the principle of the greater good? Is it for the greater good?

It is high time true open and honest debate happens. Read the links, talk to your families and friends and think. Is this what we want? The powers that be consider your assent as consent. The general consensus wins.

There should be no division, no medical apartheid and no pitching people against each other. There should be no pressure or coercion. All attempts to limit bias should be made. And people should be left to make their own decisions. Only then could anything close to informed voluntary consent be possible.

Details here is a link for Doctors For Covid Ethics, outlining concerns regarding the Covid 19 pandemic.

More information on the legal position and consent go here.

Covid Vaccine VAERS database go here.

MHRA ellow Card information, go here.

References

1. Beauchamp, T. L., & Childress, J. F. (2012). Principles of biomedical ethics. Oxford: Oxford University Press. Google Scholar 
2. Gillon, R. (2003). Ethics needs principles—Four can encompass the rest—And respect for autonomy should be ‘first among equals’. Journal of Medical Ethics, 29(5), 307–312. Article
3. Christman, J (2015) Autonomy and Liberalism: A Troubled Marriage? in Steven Wall (ed.), The Cambridge Companion to Liberalism, Cambridge: Cambridge University Press, pp.141–62.
4. Kinsinger, F (2010) Beneficence and the professional’s moral imperative. Journal of Chiropr Humanit. Dec 16 (1).
5. Cahana A, Hurst SA. Voluntary informed consent in research and clinical care: an update. Pain Pract. 2008 Nov-Dec;8(6):446-51. doi: 10.1111/j.1533-2500.2008.00241.x. PMID: 19000172.