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Covid Vaccination Ethics Essay

As many of you will know I really started this blog to talk about diet and health – and I will be continuing this long term .However through the pandemic I have written a few articles about my concerns of it’s handling and the changes to our society this has brought / may bring about.

This post is an essay I wrote for myself and then decided to send out to colleagues. I have not had a huge amount of feedback from it – so I don’t know if it has sparked debate, been ridiculed or been simply accepted as obvious, but for various reasons I have now decided to make it public. Some of it is thankfully moot now as the horrible idea of vaccine mandates has gone away (for now) in the UK…. but there are wider principles here that I think we all need to keep in our minds.

This therefore is a summary of my learning over the last 2 years and particularly the last 8 months. The conclusions are those I have come to personally from my extensive reading. I realise that others may not draw the same conclusions, although I do believe that the ethical guidelines we are expected to follow are fairly clear. I hope and pray you (particularly fellow medical professionals) find it useful and informative.

The references I have included are a small subset of all the information I have taken in over the last 18 months or so. Whilst they are not all related directly to the vaccination / mandate they have all gone some way to shaping my current understanding and views. I have tried to order and sort them for ease.

INTRODUCTION TO ETHICAL GUIDANCE

As Doctors we are bound by various oaths and asked to follow numerous pieces of ethical guidance. The documents that I feel are pertinent for GPs being asked to either take part in the vaccination campaigns or provide exemptions are:

  • The Hippocratic Oath / Declaration of Geneva
  • The International Code of Medical Ethics
  • The UNESCO declaration on Bioethics and Human Rights
  • The GMC’s Good Medical Practice
  • The Nuremberg Code

The following are the most relevant statements from those documents:

Declaration of Geneva (2006)

  • I solemnly pledge to consecrate my life to the service of humanity;
  • I will practice my profession with conscience and dignity;
  • The health and wellbeing of my patient will be my first consideration;
  • I will not use my medical knowledge to violate human rights and civil liberties even under threat.

International Code of Medical Ethics (2017)

A physician shall –

  • Always exercise his/her independent professional judgment and maintain the highest standards of professional conduct.
  • Respect a competent patient’s right to accept or refuse treatment.
  • Not allow his/her judgment to be influenced by personal profit or unfair discrimination.
  • Be dedicated to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity.
  • Deal honestly with patients and colleagues, and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception.
  • Not receive any financial benefits or other incentives solely for referring patients or prescribing specific products.
  • Recognize his/her important role in educating the public but should use due caution in divulging discoveries or new techniques or treatment through non-professional channels.
  • Certify only that which he/she has personally verified.
  • Act in the patient’s best interest when providing medical care.
  • Respect a patient’s right to confidentiality. It is ethical to disclose confidential information when the patient consents to it or when there is a real and imminent threat of harm to the patient or to others and this threat can be only removed by a breach of confidentiality.

UNESCO Declaration (2005, Article 6)

  • Any (all) preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information. The consent should, where appropriate, be express and may be withdrawn by the person at any time and for any reason without disadvantage or prejudice.

GMC – Good Medical Practice (subsection: Ethical Guidance for Doctors – Decision Making and Consent. Paragraphs 69-75 in particular)

  • Many factors influence patients’ decision making, but it’s important that nothing influences a patient to such an extent that they can’t exercise free will. If a patient can’t make a decision freely, they won’t be able to consent
  • Patients may feel pressure to have particular treatment or care. Pressure can come from others – partners, relatives or carers, employers or insurers – or from patients’ beliefs about themselves and society’s expectations.
  • You should be aware of this possibility and of other situations in which patients may be particularly vulnerable or susceptible to pressure
  • You should do your best to make sure patients reach their own decision, having considered relevant information (see paragraph 10) about the available options, including the option to take no action. You should support them to make a decision, following the steps in paragraphs 27–30 as well as:
  • giving them more time and a safe, quiet space to consider the options
  • making sure you have an opportunity to talk to them on their own
  • signposting them to specialist support services.
  • You must make sure your patient is aware that they have the right to choose whether or not to have treatment. You should not proceed with treatment or care if you don’t think it will serve the patient’s needs.
  • If, after following the guidance in paragraphs 72–74, you still believe a patient is under such extreme pressure to agree to or refuse a particular intervention that they can’t exercise free will, you should seek advice through local procedures, consult your medical defence body or professional association or seek independent legal advice. The Court may be able to make declarations and orders to protect adults where they are not able to freely make a decision.

The Nuremberg Code

My inclusion of the Nuremberg Code here is possibly controversial as it relates only to experimental treatments. Whether it therefore applies depends on whether you believe the vaccines still fall into the category of experimental. Having looked at a wide range of opinions and data, I believe they do however, I hope even if you do not feel this element is relevant, you will see the ethical principles above as enough to have concerns.

Whilst it is true that many aspects of drug development and approval are held up by red tape, and maybe do not need to take the full 10 years that is often quoted, it is also true that long term safety data, by its very definition, cannot be obtained truthfully in short-term or reduced length trials.  The phase 3 trials, of all the covid vaccines to date, are still underway and the first reporting form them is not due until 2023. For this reason I think it is relevant and appropriate to include the Nuremberg statements. Statements 1,3 and 10 are the most relevant.

  • Statement 1: The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision. This latter element requires that before the acceptance of an affirmative decision by the experimental subject there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person which may possibly come from his participation in the experiment. The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs, or engages in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity.
  • Statement 3: The experiment should be so designed and based on the results of animal experimentation and a knowledge of the natural history of the disease or other problem under study that the anticipated results justify the performance of the experiment.
  • Statement 10: During the course of the experiment the scientist in charge must be prepared to terminate the experiment at any stage, if he has probable cause to believe, in the exercise of the good faith, superior skill and careful judgment required of him, that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject.

THE ILLNESS, BASIC IMMUNITY AND THE VACCINES

Since SAR-CoV-2 emerged in late 2019 the understanding of it has grown, and the virus has mutated. We know that Omicron is much less lethal that Alpha. We know that over the 2+ years so far there have been literally thousands of strains and sub-strains (see references). We also know that in general the lethality in the older population and those with metabolic syndrome related disease is higher than that of flu, and in the younger and healthy population it is significantly less than flu. The most up to date IFRs show figures 4.9% for over 70s, dropping to 0.0013% in <19s. This includes data up until mid-2021, so does not include Omicron data. (Omicron is showing lower IFRs across the world in vaccinated and unvaccinated).  (See references).

Data on infection rates and hospital admission is on the ONS website, but can be quite difficult to interpret in terms of what it might show for an individual. However there is an API website which is more easily navigated and can be helpful. https://app.powerbi.com/

We now also have data from across the world, but particularly from Israel who have been ahead of the game in their information gathering, that suggests natural immunity confers both broader and longer lasting protection than vaccine immunity (see references). There are other studies that find vaccine immunity may be better in the short-term, but at what cost – both financial and health risk?

Where it is safe to do so, allowing natural infection could give better immunity to the individual, and give us useful data to study this further. Long-term it is very likely to provide better herd protection, especially given how soon people have been needing vaccine boosters. Independent studies in this area are much needed. It is for these reasons that I think it is good that we were able to vaccinate the old and vulnerable – those for whom it is not “statistically safe” to catch Covid – but not necessarily good to vaccinate those who are statistically at very little risk (either due to age / health, or having recovered from a previous Covid infection).

We in the GP profession are used to providing the service of vaccination, and usually do so willingly and without worry. However I believe there are differences in this vaccination programme that we should potentially be concerned about:

  • Vaccinate those for whom this illness poses almost no risk
  • Vaccinate those who have already recovered and therefore have immunity
  • Vaccinate those who are being (even willingly) coerced – initially free football tickets / cinema tickets / fast food vouchers, now escalated to “no jab no job”
  • Vaccinate without providing risk benefit analysis / discussion
  • Use a product still in phase 3 trials (not due to finish until 2023) and under EUA*, giving it to large swathes of the fit and healthy population, without due and appropriate information.

On top of this we now know the effectiveness of the Covid vaccine is well below what was initially thought and what it would need to be if we were wanting to aim for wiping it out / stopping it in its tracks. (see references). We can also clearly see that even these effects are waning against the newer strains (Dr Steve James describes this well).

With regards to safety, the data from the Yellow Card reporting system and the US equivalent (VAERS) is damning (see references). Even allowing for an element of population hysteria and therefore increased reporting numbers, the safety profiles of these vaccines appear “problematic” to say the least. There are known and acknowledged short-term risks including myocarditis, blood clots (including VITT), neurological disorders (including Bell’s Palsy, Transverse Myelitis and Guilenne-Barre Syndrome) and anaphylaxis, and the long-term risks are completely unknown – including any impact on fertility, carcinogenesis or autoimmunity – as the vaccines have not completed phase 3 safety trials (see letters linked and references within them).

Finally, these vaccines are not fully approved. They have Emergency Use Authorisation only. I have looked at how this is granted, and it can only be granted IF there are no alternative established treatments available. The wording of this could mean that there would have to be an alternative vaccine, however as the vaccine trials have only looked at reducing severity of symptoms it ought to mean there is no other drug that would reduce the severity of the symptoms. I am not convinced that this is the case (see references).*

CONCLUSION

Firstly as a doctor my first obligation is to the patient in front of me. Failure to act in my patient’s best interest is criminal negligence. (see references) In my 20 years so far in medicine there have been a handful of occasions where I have felt a pull from relatives / colleagues / bosses to do one thing, but have felt I needed with the patient’s permission and in the patient’s best interest to do something else… but only a handful, and in reality only minor – things like sending an elderly man back to hospital when he was obviously (and he agreed) discharged too soon, despite his wife asking him to “see if he could cope at home” and the on-call not being keen to have him back; or fighting for a patient to be moved by the council from third top floor flat when they had suffered an RTA leaving them with severe back problems and an amputated leg. But generally I have found that in the UK, with free-at-the-point-of-service healthcare the patient’s best interests, the policies and procedures of the NHS and actions of all professionals involved have tallied up.

However now I believe that situation has changed. 

I consider that, as a doctor, I have been placed directly between our patients and the state. – The state gives me my livelihood, but I owe my patients my best ethics and morals.

Currently it seems to me that as a doctor I am in a position where in order to protect patients and uphold the ethics on which our profession is built I will knowingly have to go against the express wishes of the state and their policies which are being enacted by the NHS.  

The government has asked my profession (General Practitioner) to ensure that as many people in the population are vaccinated against Covid as possible, and they have asked those working in mainstream NHS General Practice to deliver that vaccination programme. Within that policy is: the inclusion of those for whom the illness of Covid presents almost no risk; those who have recovered already from Covid and therefore have a reasonable (if not excellent) degree of immunity; and now also some for whom it is no longer a free choice to which they can legally consent.  (See references below).

I do not understand how as a doctor, upholding the ethics above, I can ignore the threat of mandatory vaccination (or other intervention) and practice without protest in an environment whereby our ethics have been usurped. If mandatory vaccination of NHS staff (and already of social care staff) goes ahead I do not see how it is possible to fully uphold the ethics above. If I choose to remain in the system to try and protect as many patients as possible from the corruption that loss of ethics brings, I conclude that I must exempt a healthy working age individual from vaccination if they ask for it and I must continue to fight against the use of any mandatory interventions in this and future situations.

Furthermore I conclude that I am not able to recommend vaccination, or partake in the delivery of the vaccination programme, of anyone under 18 (and probably under 24 or even 30) who is otherwise healthy, as I believe the risks of vaccination outweigh the benefits for these individuals. (see open letters and safety concerns references)

Secondary to this I also believe that as these drugs do likely fall under criteria of the Nuremberg Code, given that their phase 3 trials do not come to an end until 2023, the level of consent required (and the amount of time needed to ensure each patient is aware of their position) renders the programme of mass vaccination impossible and therefore I am not able to participate in that programme. I do not believe that the mass vaccination programme of those who are fit, healthy and at low risk has been ethical, moral or justified, and therefore I believe that I have a duty to act (in the best interests of my patients) to discourage those for whom risks of vaccination could well outweigh benefits.

Furthermore I have come to believe through writing this, that it is the failure of the medical profession to stand strongly on our ethical principles and scientific understanding from the start that has allowed things to get this far and vaccination mandates to even be considered. Others have suggested that maybe we just retreat and count this as “losing a battle” rather than walking away from the war, however I believe that this is sacred ground we would be giving up, and that return from that is likely impossible without many more casualties along the way. 

This is a subject on which I believe the medical community should have come together so that we could dialogue, stick to our medical guidelines and treat each other and our patients with compassion and respect. In many ways it seems that the time for debate is past, and it deeply saddens, and at times angers, me that more in our community are not standing up or openly wrestling with these issues. However it is never too late to start standing up for what is right, and I hope I and others can continue to do that throughout my lifetime. 

ADDENDUM: I understand the vaccines now have CMA (Conditional Marketing Authorisation) rather than EUA – The MHRA describe CMA as being granted “where there is comprehensive clinical data that is not yet complete, but it is judged that such data will become available soon”

REFERENCES

Strains and sub-strains

https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/

https://www.nature.com/articles/s41598-020-70827-z

Mortality Risks (general, excess deaths and by age)

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregistrationsummarytables/2017

https://freopp.org/comparing-the-risk-of-death-from-covid-19-vs-influenza-by-age-d33a1c76c198

https://ourworldindata.org/grapher/excess-mortality-p-scores-average-baseline?country=NOR~GBR~USA

https://ourworldindata.org/excess-mortality-covid#excess-mortality-p-scores-by-age-group

https://www.nature.com/articles/d41586-021-01897-w

https://www.ukmedfreedom.org/open-letters/open-letter-to-mps-re-covid-19-vaccine-mandates-for-employees (contains IFRs by age group)

Natural vs Vaccine Induced immunity

https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1

https://www.science.org/content/article/having-sars-cov-2-once-confers-much-greater-immunity-vaccine-vaccination-remains-vital

Safety concerns

https://www.bmj.com/content/375/bmj-2021-068665

Emergency Use Authorisation and other treatments

https://www.duke-nus.edu.sg/core/core-regulatory-perspective/making-sense-of-emergency-use-authorisations-(euas)-for-covid-19-vaccines-and-considerations-for-the-road-ahead

https://en.wikipedia.org/wiki/Emergency_Use_Authorization

Criminal Negligence

https://www.gov.uk/government/organisations/civil-service-medical-profession/about

Extra information, and useful organisations:

https://www.covid19assembly.org/

https://www.ukmedfreedom.org/resources/evidence-database-links

https://www.promic.info/informed-consent

https://www.promic.info/discrimination

https://www.pandata.org/

https://www.youtube.com/watch?v=CwQpg62Kflg https://www.ukmedfreedom.org/open-letters/ukmfa-open-letter-to-royal-college-of-gps-rcgp-re-prevention-and-treatment-of-covid-19

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Published by ecogreengp

GP, Wife, Mum, Climate Activist, Enthusiastic Cook. Owner of a car named Leafy, a cat named Biscuit and a hamster named Carrot. Disorganised beyond belief. .... sometimes I don't even put my shoes on.

2 thoughts on “Covid Vaccination Ethics Essay

  1. I wish you were my GP Fiona! I also wish more health cafe professionals would exercise the same critical thinking. Thank you

    Like

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