This is the first chapter of a book being written to educate and effect change in practices, attitudes, and policies within the health care industry by educating you the public and empowering you to act for change. Access and Cost are issues that need to be addressed and can be addressed with a Single Payer, Universal Access for all system. But what about quality and patient rights? Learn, be empowered and act.

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Few patients realize American medicine has a long history and extensive current practice of violating anesthetized patients rights. This is done in a multitude of ways. One is Ghost surgeries, where a patient is told one person will be performing the procedure, but the operation is handed over to interns and residents to whom you have never been introduced once you are under anesthesia. The physician the patient was told would be performing the procedure may be merely supervising, or may have moved on to the next case and only be available by phone in the case of an emergency.

Students and interns, are hidden; the patient is manipulated and deceived. The patient is blatantly lied to before and after about who actually performed the procedure. Vague language in the consent form may allow for such substitutions. Other times patients are given “conscious sedation” (date rape drugs) to obtain drug facilitated signatures on consent forms when the patient is in no condition to read the form they are being asked to sign, will not likely remember the incident, and are in a drug induced mind altered (including unnaturally conciliatory) state of mind. This is a method often used on patients who staff has reason to think will not consent to substitutions, video taping, or multiple pelvic exams", adolescent girls, rape victims, religious patients, or simply a patient who wants to know and approve the experience level of the performing physician.

Once under anesthesia for surgery or colonoscopes physicians often take the opportunity to do things to patients to which they did not consent, such as teams of interns, residents, and students lining up to perform pelvic, breast, and rectal exams on sedated patients, for the sake of education. Errors are covered up, injuries denied; even molestation (medical and sexual) of sedated patients is covered up and allowed to continue. This is not the medical culture which we are lead to believe exists, where patients health, rights, and dignity are health professionals primary concern.

We are convinced that in the western world the average medical patient has established rights to dignity, privacy, and self-determination, that physicians are trained to respect and protect these rights, and any physicians found in violation are punished and/or restricted from practice . This is a perspective the public holds because it is an image that is aggressively projected and protected by medical “professionals”. It is an understanding come by via propaganda and is not reflective of reality. So, what is real?

My goal herein is to think about how we got to the point where in spite of what we are told about patient/physician relations, women are subjected to forced rape exams, non-consensual non-emergency, often even non-medically indicated pelvic exams, and more. This is a sort of “People's History” of Allopathic Medicine. With no intent to go into the detail Howard Zinn has in his books, I want to take a critical look at medical practices as they relate to violations of patient's autonomy, of the fiduciary relationship between patient and physician, how such violations are rationalized, and what needs to be done to ensure patient autonomy, dignity, and rights are respected.

I. The History:

We tend to be vaguely aware of a distant historical past of exploitive medical experiments performed upon the bodies of slaves, mental heath patients, criminals, prisoners of war, veterans, poor women and minorities. We seem to rarely know the details however, Newborns injected with radioactive substances, military personnel exposed to chemical weapons, mentally challenged children infected with hepatitis, seventy-three disabled children fed oatmeal laced with radioactive isotopes, pregnant women injected with radioactive iron,"; from it's inception allopathic or “western” medical “advancements” to a significant extent, originated from research and education methods that violate any sense of human or civil rights, autonomy or dignity. 1

At first patients wealthy and poor alike feared and avoided violent and invasive allopathic care. It was a well-grounded fear, and avoidance of the allopath was a wise decision. When medicine was diverse in theory and practice, patients had a choice of homeopathic, naturopathic, Chinese medicine, herbalists, Indian medicine, “allopathic medicine” (which became what we now know as “western medicine”), and midwives. Diet, dietary supplements, herbs, tonics, and topical, were the tools of the most scientific (empirical) medical care. Environmental exposures, bleeding, mercury poisoning, and other very unscientific methods were employed by the allopath. What became known as regular medicine was not based upon science but philosophy, theology, and myth, while traditional Chinese Medicine, homeopathic, and herbal based medical care were grounded in centuries of empirical data collection and analysis. The relative lack of success in treatment, in conjunction with the violence and death that plagued any patient who dared suffer the allopath, and given that patients had a choice, most chose NOT to seek the care of the allopath. The poor reputation of allopathic medicine in conjunction with much competition from other practitioners ensured the relative poverty of the allopathic physician. Left with few paying patients relative to other physicians, allopathic medicine was not thriving.

Opportunistic philosophers (linked to eugenics) and emerging pharmaceutical companies offered the allopath the American Medical Association (A.M.A.), an organization that would seek the elimination of competition and control over medical education and the market, ensuring the high income of the allopathic doctor. The objective of the AMA, was to eliminate patient choice, “to secure a government-enforced medical monopoly and high incomes for mainstream doctors.” 2. The A.M.A. lumped ALL sorts of medical care, including midwifery, in with snake oil salesmen, and lobbied for legislation eliminating their competition. Alternatives were all but eliminated from for-profit medical care. The poor, however, sustained medical care in the form of the old women and men passing on home remedies and basic medical knowledge.

One might assume the poor simply could not afford the allopath, or lived more remote lives, and both are true, but the situation was not so simple. While profit driven medical care was reserved for the privileged, patients with money and social status have not only the ability to pay the bill, but also the means to retaliate should the physician deviate from a professional standard of care and the patient suffer. This made the physicians paying customers risky research subjects. Physicians learned early on to treat privileged white males (those who can afford to pay for their medical care and lawyer fees) with more respect.

In the late 1700s a Mr.Slater sued a Dr. Stapleton and Dr. Baker for re-breaking a poorly healed bone. The court found in favor of Mr. Slater because the defendants acted, “contrary to known standard of care and did so without the informed consent of the subject.” Although, the treatment turned out to set a new standard of care in the end, the courts decision did not turn on the success of the experiment, but on the lack of informed consent, that the patient, "...may take courage and put himself in such a situation as to enable him to undergo the operation". 3. (Slater v Baker and Stapleton (1797) 95 English Reports 860.)

Physicians not eager to give up their Godlike position to treat people as less that full subjects; but, also wanting to make money without being sued, learned to treat the more privileged according to the standard of care, and experiment on those less likely to sue. While being offered little in terms of medical care (medicine administered in their interest), these subjugated groups served as a resource for human lab rats upon which to test this or that drug, treatment, or procedure. Financial and other coercive means were employed in some cases, others downright deception. Informed consent, in any meaningful sense of the word, was rarely sought. Thus, the poor had more than simple economic inability to pay keeping them from seeking medical care from “outsiders”, and in particular from the allopath. 4.

With the advent of surgery; however, physicians needed more than lab rats, they needed living cadavers. While drafted soldiers may “volunteer” to be lab rats in order to avoid being sent to kill others, and many patients can unknowingly be injected with this or that, surgical experimentation presents the problem of being impossible to hide from the patient. Given the extreme nature of surgery and the very high infection rate at the time, (rendering surgery a very risky proposition), it was virtually impossible to acquire “consent“.

The allopath turned to non-free peoples as a resource for breathing cadavers. Subjects with absolutely no freedom to object, slaves, poor mental health patients, and prisoners of war became prime targets for some of the most vial forms of human exploitation. Dr J Marion Sims,(1813-1884) the “father of modern Gynecology”, and the first physician to have a statue erected in his honor in the United States, provides a particularly atrocious, if not unique, example. Doctor Sims avoided the problem of a scarcity in “voluntary” subjects by using African American slave women. The problem of patient autonomy and the need for consent was avoided, and not thinking of the women as human subjects, Dr. Sims operated on his slave and Irish female subjects without anesthesia, something he dare not do to women of privilege. The condition for which Sims sought a cure, " was largely caused within the slave population by malnourishment and/or pregnancies at a young age, such that the pelvic was underdeveloped leading to prolonged obstructed labors. Dr. Sims not only did not do anything to help the condition of these women, he used them, and their unborn. Most of the women used in his experiments died, many after suffering for weeks. When slave owners refused him further access to their property, he purchased slaves, the first a seventeen year old slave girl he called Anarcha for $500 upon which he performed over 30 operations within a few months in spite of the fact that his own records indicate she was cured after the 13^th surgery. There is no reason to assume the slaves he purchased (particularly given the price) were always afflicted prior to Sims' experiments. Anarcha's condition (several vaginal tears) was the result of a three-day labor, and then a rough forceps (another of Sims' inventions) assisted delivery by Dr. Sims, an experimental procedure in which he had no previous experience, using an experimental tool still controversial to this day. While you can read modern apologists who insinuate that these procedures may have been voluntary, these women were slaves, anesthesia was not used (until post surgery so Sims would not have to listen to their moans), and the number of surgeries performed on single subjects were in the double digits. People were asked to hold the women down, most of who after a couple of times could no longer stomach the task, nor Dr. Sims. 5 There is every reason to assume the bulk of these women did not “volunteer” and the girl(s) he purchased most certainly did not.

Apologists also argue that without this sort of violence and abuse the achievements of Sims would never have been enjoyed by millions of women today. This is an obvious logical fallacy as there is no reason to assume that similar (perhaps less violent) procedures would not have been developed by other physicians. More than logical fallacy, historical evidence refutes the claim. In fact, Sims was not the first to repair vesicovaginal fistulas successfully. Twenty-five years before Sims' experiments (from 1845 to 1849) Montague Gosset in England had used silver wire in a fistula repair, and the use of lead shot to hold wire sutures in place was also known. In 1836, John Peter Mettauer in Virginia and, in 1839, George Hayward in Massachusetts succeeded in closing fistulas. 6. Thus, there is no reason to assume that only Sims could have copied and published these achievements. There is no reason to assume such advancements require such violations of human autonomy. Many contemporaries made medical advances without the use of captive patients. Ephraim McDowell of Kentucky, who in 1809 performed the first successful abdominal operation, and Crawford Long of Georgia, who in 1842 used ether as an anesthetic for the first time, to name just two, both used informed, free, white patients.

Many medical anti-ethicists, as they can only descriptively be called, argue that Sims must be judge by the standards of his time, not ours. However, many speculate Sims left the South due to significant criticism. His colleagues at a Woman's Hospital Sims help found were so critical of Sims' unethical experimentation that they voted to ban his cancer surgeries and limit the number of spectators in attendance at surgeries. Eventually, his colleagues so feared for the lives of patients at the hospital they invited Dr. Sims to leave the Hospital. His brother-in-law, also a physician, pleaded with Sims to give up his surgeries. James Simpson of Edinburgh, pointedly remarked in critic of Sr. Sims, "I took occasion to make an extensive series of experiments ... [on] a number of unfortunate pigs, which were always, of course, first indulged with a good dose of chloroform." 7. Nor was Sims a Calvinistic practitioner who did not believe in anesthesia, as he did give his victims chloroform post surgery, if only so he did not have to listen to their moans from the pain.

Given Sims experiments (as he brutally carried them out) would not have been possible had his subjects not been slaves, given such abuse was not necessary for the “advancement of women's medicine”, given the criticism of his own contemporaries, and given both slavery and non-consensual experimental procedures have come under mass social critic and legal restraint one might find it hard to understand why contemporary medical ethicists might defend Sims' experiments. Still, many physicians are irrationally emphatic about in their defense of Dr. Sims, arguing the end justified his means. I am convinced, and evidence suggest, they do so not because their argument is well supported by reason or evidence, but because they feel they have a vested interest in opposition to patient autonomy and the ethic against violating informed consent, they have a vested interest in treating the rich and subjecting the poor to violent abuses against patient autonomy, dignity, and health.

To be Continued: In the next chapter I will talk about current practice. We will also address physician justifications for violations of Kant's moral imperative, their fiduciary duties, and Hippocratic oath. Finally we will propose legislation to address these violations and an opportunity for you to act.

1.

Vaccines and Medical Experiments on Children, Minorities, Woman and Inmates (1845 - 2007), Friday, December 14, 2007 by: Mike Adams, Natural News Editor

BITTER PILL : Disseminating Truth And Fighting Tyranny

http://www.homersbitterpill.com/2008/12/human-medical-experimentation-in-united.html

Race,　Health Care and the Law　Speaking Truth to Power! Basis of Distrust

http://academic.udayton.edu/health/05bioethics/slavery02.htm

Human medical experimentation in the United States: The shocking true history of modern medicine and psychiatry (1833-1965)

Toxins in the Bodies of Newborns Lead to a Contaminated Generation

9/9/2008 - (NaturalNews)

Hepatitis B Vaccine: Good for 'Newborn' Prostitutes and Drug Users, but Who Else? 7/11/2008 - (NaturalNews)

2.

AMA's stated purpose

3.

(Slater v Baker and Stapleton (1797) 95 English Reports 860.)

4.

http://jme.bmj.com/cgi/content/full/34/3/180#B12

http://jme.bmj.com/cgi/content/abstract/32/6/346

http://jme.bmj.com/cgi/content/full/34/3/180 \ B19

http://shm.oxfordjournals.org/cgi/content/abstract/20/2/223

http://jme.bmj.com/cgi/content/full/34/3/180 \ B18

http://www.naturalnews.com/022383.html

5.

(James Marion Sims: some speculations and a new position Caroline M de Costa MJA 2003; 178 (12): 660-663)

McGregor DM. Sexual surgery and the origins of gynecology: J. Marion Sims, his hospital, and his patients. New York, Garland Publishing, 1989:47.)

6.

Kaiser IH. Reappraisals of J. Marion Sims. Am J Obstet Gynecol 1978; 132:878-884.

Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.

7.

Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.)

　

Authors Website: http://www.patrickdodd.com

Authors Bio:
Just one citizen struggling to regain American Democracy. I am a bit of a intellectual jack of all trades master of none. I have studied, economics, sociology, philosophy, womens studies, and political science at a graduate level.