The "ETHICS IN MEDICINE" section of the University of Washington School of Medicine website contains a "Principles of Bioethics" segment.  This portion of the website summarizes the 4 fundamental principles of bioethics I have previously discussed in this blog.  No new ground is covered in the discussions of respect for autonomy, nonmaleficence, beneficence, and justice. 

The "Principles of Bioethics" segment does, however, include an interesting subsection titled 'How do principles "apply" to a certain case?'  This subsection considers what to do when two or more bioethical principles are in conflict in an example case.  The analysis of the example case is illustrative of non-libertarian bioethical thinking.

The website example case asks the reader to "consider a patient diagnosed with an acutely infected appendix."  The reader is informed that the "medical goal should be to provide the greatest benefit to the patient, an indication for immediate surgery."  This is the principle of beneficence.  The bioethical principle in conflict with this decision, however, is the obligation to not harm a patient, otherwise known as nonmaleficence, for "surgery and general anesthesia carry some small degree of risk to an otherwise healthy patient."  The reader is advised that the appropriate course of action is to "balance the demands of these principles by determining which carries more weight in the particular case."  The conclusion for the example case is "the patient is in far greater danger from harm from a ruptured appendix if we do not act, than from the surgical procedure and anesthesia if we proceed quickly to surgery." 

The non-libertarian finds nothing controversial in the analysis of this example case.  The libertarian, however, immediately notes that the discussion completely ignores the ultimate decision-maker in this scenario.  The ultimate decision-maker, per libertarian theory, is the justly acquired property owner.  The "justly acquired property" in the example case is the appendix of the patient.  The owner of the "justly acquired property" in the example case is, obviously, the patient.  Thus, the ultimate decision-maker in the example case is the patient with the acutely inflamed appendix.  By definition, then, the physician is not the ultimate decision-maker.  The physician, therefore, cannot "proceed quickly to surgery."  The physician can only "balance the demands of these principles by determining which carries more weight in the particular case" and then give a recommendation to the patient, who will make the ultimate decision.  

This shift in focus from the physician as ultimate decision-maker to patient as ultimate decision-maker is the difference between paternalism and autonomy, aggression and non-aggression, slavery and liberty.  This distinction may seem trivial to the non-libertarian.  The libertarian, once again, knows the truth.      

An acquaintance recently requested that I read and review (on this blog) Lives at Risk: Single-Payer National Health Insurance Around the World by John Goodman, Gerald Musgrave, and Devon Herrick.  I instantaneously forgot this appeal until tonight, at which time I ordered the paperback version from Amazon.com.  A Google search, fortunately for you dear reader, revealed that a high-quality book review penned by Dale Steinreich PhD has already been published in the Fall 2006 edition of The Quarterly Journal of Austrian Economics.  

I recommend perusal of Steinreich's book review.  I cannot yet recommend purchase of the book because I have yet to scrutinize this work.  I plan to provide a succinct analysis of Lives at Risk in a future blog post. 

I recommend a perusal of the short July 14, 2010 article "Secrecy and Deadly Radiation: On the Birth of the Nuclear Age 65 Years Ago" by Greg Mitchell published on The Nation website.  This feature details the government secrecy surrounding the July 16, 1945 Trinity test, the true dawn of the nuclear age, in the New Mexico desert.  Unsurprisingly, the author documents the biomedically unethical actions of a fascist cabal (government officials in collusion with private citizens).

General Leslie Groves, government scientist Robert Oppenheimer, and NY Times reporter W.L. Laurence merit special condemnation in the article for refusing to evacuate local residents, hiding post-Trinity health reports, and publishing government propaganda regarding the Trinity event, respectively.  All four fundamental TJ/BC bioethical principles (justice, non-maleficence, beneficence, and respect for autonomy) were violated by these actions.  The plumbline libertarian bioethicist is not surprised by the crimes of this cabal.

The author concludes the article by tantalizing the reader with a reference to the "Hiroshima Narrative."  I imagine Greg Mitchell has reported this story elsewhere.  I look forward to reading this bit of revisionist history.     

The June 2008 report "Broken Laws, Broken Lives: Medical Evidence of Torture by US Personnel and Its Impact" is another interesting Physicians for Human Rights document.  The report "provides first-hand accounts and medical evidence of torture and cruel, inhuman, or degrading treatment or punishment ("ill-treatment") of eleven former detainees who were held in US custody overseas."  I recommend review of this report by anyone with a conscience.

The eleven detainees were evaluated on study by two experienced clinicians according to the "guidelines for assessing physical and psychological evidence of torture set out in the Instanbul Protocol, Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment."  Informed consent for the study was obtained prior to clinical evaluation.  No consenting detainees were excluded from the study.

The study found that the eleven detainees experienced "torture and ill-treatment" and "resulting long-term physical and psychological harm."  Common methods of torture and ill-treatment included the following: beatings during arrest/transport/initial custody, deprivation of basic necessities and sanitary conditions, stress positions (forced standing/handcuffing/shackling), isolation, sensory deprivation, bombardment, threats of harm to detainees and their families, use of extreme temperatures, electric shocks, sexual assault, physical assault, sleep deprivation, degrading treatment (sexual/religious/cultural/other), and witnessing torture and cruel treatment.  The study also documented disturbing evidence of complicity of health professionals in the torture and ill-treatment of detainees and denial of medical care to detainees.

The study concluded that "all of the abusive interrogation techniques and patterns of ill-treatment endured by these eleven men ... constituted acts of torture as well as cruel, inhuman or degrading treatment under domestic criminal statutes and internal human rights and humanitarian treaties, including the Convention Against torture and the Geneva Conventions, that were in effect at the time the acts were committed."  The executive summary of the report mocks the US government by noting that the US State Department has identified the acts documented in the study as torture when committed by other governments.  The executive summary also mocks the US government by noting that multiple US laws identify the acts documented in the study as torture. 

The plumbline libertarian bioethicist has no qualms with the conduct or conclusions of this disturbing study.  However, the plumbline libertarian bioethicist does dispute the utility of the seven silly recommendations the study makes, for all the recommendations necessitate just action by the US government, which is clearly identified as a criminal organization in the study.  The plumbline libertarian bioethicist, instead, recommends, at a minimum, separation of medicine and state, and, ideally, abolition of the state.