By Jacob M. Appel MD, JD
February 12, 2021
Source: Med Page Today
Photo Source: Unsplash, Yaopey Yong
While some medical professionals and organizations may distance themselves from torture publicly, the reality of the matter is its roots are founded in torture. Both science and medicine have to this day and historically since the tender beginning of its establishment have stated that the 'human' element must be removed from their practice. In the name of profit, scientific discovery and control the very persons they claim to heal have often be treated as test subjects and lab rats to their on ends. The question is often asked how can you treat the health of a person and take the 'human' element out of health care?
Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case, and then we provide an expert's commentary.
Last week, you voted on whether you thought a physician was being asked to support torture.
Is it ethical for the doctor to play this indirect role in the interrogation? Yes: 50% No: 50% Is it ethical for the doctor to decline this role? Yes: 79% No: 21%
The canons of medical ethics have long banned physicians from participating in torture. These proscriptions were explicitly laid out in the World Medical Association's Declaration of Tokyo (1975), the United Nations Principles of Medical Ethics (1982), and the United Nations Convention against Torture (1984). The American Medical Association Code of Medical Ethics goes one step further, noting that "physicians must not be present when torture is used or threatened." The AMA code also warns that "physicians may treat prisoners or detainees if doing so is in their best interest, but physicians should not treat individuals to verify their health so that torture can begin or continue." Whether "enhanced interrogation techniques" used by the U.S. military constitute torture has been a matter of considerable controversy. In preparing for the interrogation of detainees at Guantanamo Bay in the early 2000s, Deputy Assistant Attorney General John Yoo and Assistant Attorney General Jay Bybee advised the Bush administration that such techniques did not constitute torture. Critics, such as Physicians for Human Rights, strongly disagree.
While the AMA and the American Psychiatric Association forbid members from participating in enhanced interrogation, the American Psychological Association once sanctioned such engagement. Two psychologists allegedly participated in guiding the examination of Al-Qaeda prisoners. They were later sued by the American Civil Liberties Union on behalf of several of these detainees; the case was settled on terms that have not been publicly disclosed.
In our hypothetical, John Banner, MD, is not being asked to participate directly in enhanced interrogations. Rather, he has been informed that such interrogation will occur with or without his presence; his sole role is to aid prisoners who suffer negative medical consequences. Yet some of those patients could theoretically be revived by him only to face more questioning. Under the circumstances, if these techniques are indeed torture, he is rendering assistance that might permit it to continue. The scenario, in essence, asks how complicit one must be in unethical conduct before one suffers moral responsibility for that conduct. These same questions arise in a number of areas where physicians interface with law enforcement. For instance, now that most major medical organizations have prohibited physician participation in capital punishment, one must ask whether psychiatrists are permitted to certify that patients have the capacity to understand why they are being executed -- a U.S. Supreme Court requirement for such executions to go forward.
Banner may legitimately feel he is helping these internees by making himself available to provide emergency care. However, he must balance those noble intentions against the harm he may do by lending his good name, and the good name of his profession, to legitimizing potentially unethical behavior.Henrietta Lacks estate sues company using her ‘stolen’ cells
Oct 6, 2021 5:02 PM ED T COLLEGE PARK, Md. (AP) — The estate of Henrietta Lacks sued a biotechnology company on Monday, accusing it of selling cells that doctors at Johns Hopkins Hospital took from the Black woman in 1951 without her knowledge or consent as part of “a racially unjust medical system.”
Tissue taken from the woman’s tumor before she died of cervical cancer became the first human cells to be successfully cloned. Reproduced infinitely ever since, HeLa cells have become a cornerstone of modern medicine, enabling countless scientific and medical innovations, including the development of the polio vaccine, genetic mapping and even COVID-19 vaccines.
Lacks’ cells were harvested and developed long before the advent of consent procedures used in medicine and scientific research today, but lawyers for her family say Thermo Fisher Scientific Inc., of Waltham, Massachusetts, has continued to commercialize the results well after the origins of the HeLa cell line became well known.
“It is outrageous that this company would think that they have intellectual rights property to their grandmother’s cells. Why is it they have intellectual rights to her cells and can benefit billions of dollars when her family, her flesh and blood, her Black children, get nothing?” one of the family’s attorneys, Ben Crump, said Monday at a news conference outside the federal courthouse in Baltimore.
Johns Hopkins said it never sold or profited from the cell lines, but many companies have patented ways of using them. Crump said these distributors have made billions from the genetic material “stolen” from Lacks’ body.
Another family attorney, Christopher Seeger, hinted at related claims against other companies. Thermo Fisher Scientific “shouldn’t feel too alone because they’re going to have a lot of company soon,” Seeger said.
The lawsuit asks the court to order Thermo Fisher Scientific to “disgorge the full amount of its net profits obtained by commercializing the HeLa cell line to the Estate of Henrietta Lacks.” It also wants Thermo Fisher Scientific to be permanently enjoined from using HeLa cells without the estate’s permission.
On its website, the company says it generates approximately $35 billion in annual revenue. A company spokesman reached by telephone didn’t immediately comment on the lawsuit. HeLa cells were discovered to have unique properties. While most cell samples died shortly after being removed from the body, her cells survived and thrived in laboratories. This exceptional quality made it possible to cultivate her cells indefinitely — they became known as the first immortalized human cell line — making it possible for scientists anywhere to reproduce studies using identical cells.
The remarkable science involved — and the impact on the Lacks family, some of whom suffered from chronic illnesses without health insurance — were documented in a 2010 bestselling book, “The Immortal Life of Henrietta Lacks.” Oprah Winfrey portrayed her daughter in an HBO movie about the story. The lawsuit was filed exactly 70 years after the day she died, on Oct. 4, 1951.
“The exploitation of Henrietta Lacks represents the unfortunately common struggle experienced by Black people throughout history,” the suit says. “Indeed, Black suffering has fueled innumerable medical progress and profit, without just compensation or recognition. Various studies, both documented and undocumented, have thrived off the dehumanization of Black people.”
Shobita Parthasarathy, a University of Michigan professor of public policy who has researched issues around intellectual property in biotechnology, said the lawsuit comes at a time when Lacks’ family is likely to have a sympathetic audience for their claims.
“We are at a moment, not just after the murder of George Floyd but also the pandemic, where we have seen structural racism in action in all sorts of places,” she said. “We keep talking about a racial reckoning, and that racial reckoning is happening in science and medicine, as well.”
A group of white doctors at Johns Hopkins in the 1950s preyed on Black women with cervical cancer, cutting away tissue samples from their patients’ cervixes without their patients’ knowledge or consent, the lawsuit says.
Johns Hopkins Medicine says it reviewed its interactions with Lacks and her family over more than 50 years after the 2010 publication Rebecca Skloot’s book. It says it “has never sold or profited from the discovery or distribution of HeLa cells and does not own the rights to the HeLa cell line,” but it has acknowledged an ethical responsibility.
Crump, a Florida-based civil rights attorney, has risen to national prominence representing the families of Trayvon Martin, Michael Brown, Breonna Taylor and George Floyd — Black people whose deaths at the hands of police and vigilantes helped revitalize a national movement toward police reform and racial justice.
Seeger, a New Jersey-based corporate litigator, has represented thousands of former NFL players in a class action settlement over concussions and was a lead negotiator of Volkswagen’s $21 billion diesel emissions settlement with car owners.
Thermo Fisher Scientific’s website says the company generates revenue from four business segments: life sciences, analytical instruments, specialty diagnostics, and laboratory products and services. One of Henrietta Lacks’ grandsons, Lawrence Lacks Jr., said at Monday’s news conference that the family is “united” behind the case.
“It’s about time,” said another grandson, Ron Lacks. “Seventy years later, we mourn Henrietta Lacks, and we will celebrate taking back control of Henrietta Lacks’ legacy. This will not be passed on to another generation of Lackses.”
Associated Press reporter Aaron Morrison in New York City contributed to this report.
How does the history of medicine impact your health care? If you were apart of a medical experiment would you know it? Are your medical records monetized (digitally)?
If this article was helpful to you, donate to the Shidonna Raven Garden and Cook E-Magazine Today. Thank you in advance.
Comments