NADINE Montgomery has diabetes and is of small build. While pregnant she asked her doctor repeatedly if her baby’s size would be a risk if she had a vaginal delivery, but her questions ‘were not really answered’. Nadine’s baby experienced inadequate oxygen levels and has cerebral palsy as a result. She sued for negligence, arguing that had she known of the increased risk, she would have requested a caesarean section. The Supreme Court of the UK found in her favour in March 2015.
Informed consent to medical interventions has been necessary for many years, so long as a doctor’s decision was supported by a ‘responsible body of clinicians’. But now, thanks to Nadine’s courage, the law entirely reflects the interests of the subject whatever the health professional thinks. Obtaining consent to interventions where there are foreseeable risks that may affect a person’s physical or mental health has become an absolute principle in healthcare law and ethics. There is now no doubt that the most basic ethical requirement on doctors – and other professionals – is to give balanced, factual information explaining the benefits and risks of a proposed course of action. Above all else you must be honest. If the patient declines an intervention, no matter how much you believe it to be in their best interests, you cannot legally or ethically carry it out.
Chris Whitty and Patrick Vallance, the government’s chief advisers, are both medically qualified. They are surely aware of the importance of informed consent in medical law and ethics, and yet they continue to be complicit in endless breaches of it.
One of their most stunning contraventions of accepted moral standards was their approval of recommendations from behavioural science experts made in a sparsely argued paper written on March 22, 2020.
The document set out options for increasing adherence to social distancing measures. These included intentionally heightening ‘the perceived level of personal threat . . . among those who are complacent, using hard-hitting emotional messaging’, changing the ‘messaging around (sic) the low level of risk to most people’, using coercion ‘to compel key social distancing measures’ and fostering ‘social disapproval’ for failure to comply. The proposals were discussed and agreed the next day by both chief advisers at Sage meeting 18, chaired by Vallance.
In simple language, the Sage behavioural science sub-group (SPI-B) who authored the paper argued that the government should purposely frighten people into changing our behaviour by targeting emotive messages at our human vulnerabilities, should deny the scientific fact that Covid-19 is not a ‘high consequence infectious disease’ (Public Health England’s official position), and should force people to obey the rules, however often they change and however baseless the science which supposedly informs them.
So let’s be quite clear. Deliberately setting out to scare people is not ethical, whatever the end you are trying to achieve. Deliberately exaggerating risks, continually manipulating evidence, coercing people to stop normal human behaviours, using blatant propaganda to turn citizens into guilt-mongering agents of social control is not ethical either.
Ethics is not science. It is contestable. You cannot absolutely prove that a behaviour is ethical or unethical. But it does not follow that ethics can mean anything, and it certainly does not follow that if you are professionally committed to fundamental ethical principles you can advise exactly the opposite. At the very least you must be consistent. However much your peer group convinces itself otherwise, you cannot with any credibility have it both ways.
There is a general way to think of ethics with which almost all scholars in the field would agree. Namely, a decision designed to enhance knowledge and choices is prima facie ethical while a decision to indoctrinate and limit options is not. Full stop.
Just as it was not ethical to decide how Nadine Montgomery should deliver her baby without her involvement and consent, it is not ethical for professionals to disregard completely legally grounded Codes of Ethics. The constant propaganda, positioning by the media, and infantilisation of the population is pointedly unethical. Had citizens been officially informed in the spring of the increased risks to human and economic wellbeing foreseeable because of government policy, we would surely have demanded alternatives.
Cherished standards of truth, honesty, journalism, political debate and plain credibility have been thrown to the winds by supposedly educated people who presumably consider themselves upstanding citizens. Tragically, the perpetrators are not only unaware of their vandalism, they congratulate themselves on it.
Were they to be judged by normal professional criteria, fought for by many thousands of citizens for over half a century, Professors Whitty and Vallance would both be struck off, along with the other one-eyed advisers who have so casually disregarded scientific and ethical standards.
