The event: “Medicine, Science and Public Health: Restoring Trust and International Ethical Principles,” premiered March 20, 2022. What follows is a complete transcript of this important meeting.
Moderator: Dr. Kulvinder Kaur Gill, MD, FRCPC, President and Co-Founder of Concerned Ontario Doctors, Frontline Physician
Dr. Asa Kasher, PhD, Professor of Professional Ethics and Philosophy, Tel Aviv, Israel
Dr. Aaron Kheriaty, MD, Physician and Medical Ethicist, California, USA
Dr. Julie Ponesse, PhD, Former Professor of Ethics and Philosophy, Ontario, Canada
Dr. Richard Schabas, MD, MSHC, FRCPC, Former Chief Medical Officer of Health for Province of Ontario, Retired Physician
Dr. Kulvinder Kaur Gill:
Welcome. Thank you for joining us today for Concerned Ontario Doctors’ Second COVID-19 Summit. Our first summit in April of 2021 had focused on the harms of lockdowns, the dangers of censorship and a path forward with the authors of the Great Barrington Declaration. My name is Dr. Kulvinder Kaur Gill. I’m the president and co-founder of Concerned Ontario Doctors and a frontline physician in the Greater Toronto Area. I am honored to be the moderator today for Concerned Ontario Doctors’ Second COVID-19 Summit. I’m joined by esteemed professors and physicians from around the world today to discuss restoring trust and international ethical principles in medicine, science, and public health.
I am pleased to introduce our first panelist, Dr. Aaron Kheriaty. He is a psychiatrist and medical ethicist. Dr. Kheriaty is current the chief of Medical Ethics at the Unity Project. He is a fellow and director of the program in Bioethics and American Democracy at the Ethics and Public Policy Center and a senior fellow and Director of Health and Human Flourishing program at the Zyphre Institute. Dr. Kheriaty holds the positions of scholar at the Paul Ramsey Institute, senior scholar at the Brownstone Institute, and he serves on the advisory board at the Simon Simone Weil Center for Political Philosophy Center for Political Philosophy for many years. Dr. Kheriaty was a professor of Psychiatry at the University of California, Irvine, School of Medicine and director of the Medical Ethics program at UCI Health, where he chaired the Ethics Committee. Dr. Kheriaty has also chaired the Ethics Committee at the California Department of State Hospitals for several years. He has testified on matters of public policy, healthcare and pandemic policies. Dr. Kheriaty has also authored several books and articles for professional and lay audiences on bioethics, social science, psychiatry, religion, and culture. Thank you so much for joining us today.
Dr. Aaron Kheriaty:
Dr. Kulvinder Kaur Gill:
Next, joining us from Israel, we have Dr. Asa Kasher. He is a professor emeritus of Professional Ethics and Philosophy of practice and professor emeritus of Philosophy at the Tel Aviv University. Dr. Kasher is also a member of the European Academy of Science and Humanities. He has served as a member or head of numerous governmental and public committees in Israel appointed by the Prime Minister, Ministry of Health, Ministry of Defense and others. He has authored over 350 papers, ethical documents and several books, and he is the editor of several philosophy and ethics journals. Dr. Kasher has been a visiting professor and conducted research at several universities across the world, including UCLA, Amsterdam, Berlin, Calgary, Oxford, and many others. For his contributions to philosophy, he won the Prize of Israel in 2000, the highest national prize. Thank you so much for joining us today.
Dr. Asa Kasher:
Dr. Kulvinder Kaur Gill:
Next, we have returning from Concerned Ontario Doctors’ First COVID-19 Summit, the wonderful Dr. Richard Schabas. He is a retired Ontario physician with specialty training in Public Health and Internal Medicine. Dr. Schabas was Ontario’s former Chief Medical Officer of Health for 10 years, spanning from 1987 to 1997. He has trained several public health officers, including on Ontario’s recent Chief Medical Officer of Health, Dr. Williams, and many other medical officers of health. Dr. Schabas was also the former chief of staff at the York Central Hospital during SARS. He was critical of the mass quarantine during the SARS outbreak and the alarmist predictions surrounding the H5N1 bird flu. Dr. Schabas has been outspoken against the lockdowns since the beginning of the COVID-19 pandemic highlighting the tremendous harms to society. Thank you so much for joining us once again.
Dr. Richard Schabas:
Thank you for organizing this.
Dr. Kulvinder Kaur Gill:
Last, but not least, joining us from Ontario, Canada, we have Dr. Julie Ponesse. Dr. Ponesse has a PhD in Philosophy from the University of Western Ontario with areas of specialization in Ethics and Ancient Philosophy. She has a masters from the Joint Centre for Bioethics at the University of Toronto, and has additional training in Ethics from the Kennedy Institute of Ethics at Georgetown University. She has published in the areas of ancient philosophy, ethical theory, and applied ethics, and has taught at several universities in Canada and the United States for the past 20 years. In the fall of 2021, Dr. Julie Ponesse saw her academic career of 20 years fall apart after she refused to comply with a Canadian university’s COVID vaccine mandate. In response, Dr. Ponesse had recorded a special video directed to her first year ethics students, which was watched across the world. Dr. Ponesse has since joined the democracy fund as a pandemic ethics scholar, focusing on educating the public on civil liberties and is the author of her new book, My Choice: The Ethical Case Against COVID Vaccine Mandates. Thank you so much for joining us today.
Dr. Julie Ponesse:
Thank you, Kulvinder. It’s a true honor.
Dr. Kulvinder Kaur Gill:
I’m delighted that all of you could make the time for this very important discussion surrounding ethics in the scientific, medical and public health policies that have been implemented over the past, now two years, by our governments across the world for COVID. I would like to have the opportunity to discuss many facets of government policies. First, starting with lockdowns. Now, some of the most lockdown places in the world have been where many of you actually reside. Globally, we have seen governments and their advisors admit to use of harmful fear messaging. What are the ethical implications of imposing such unprecedented measures, particularly when known to harm the most marginalized, and how do we reconcile these irreparable harms knowing how jurisdictions without lockdowns, such as Sweden and Florida, for example, have fared with their emphasis on focused-protection for people at high risk? If we could begin with Dr. Kheriaty.
Dr. Aaron Kheriaty:
In retrospect, we can see now that the lockdowns didn’t accomplish their purpose of the spread of COVID, but even at the time when they were implemented, there was inadequate discussion, reflection and analysis on what the consequences of this really unprecedented policy would be. This is the first time in human history that we have quarantined healthy populations. There’s a reason that we’ve never done that before. It doesn’t make good public health sense. And the experience of the last two years have born that out. But even without the benefit of hindsight, at the time, we should have recognized that public health is about the health of the population as a whole. It’s not just about one particular infectious disease and looking at only case curves for COVID, which is where all the focus was when the lockdowns were implemented. Hitting the pause button briefly that the notion of maybe two weeks to flatten the curve, see what was going to happen with our healthcare system, may have been justified.
But once we got through that initial period where we started learning more about the virus and what to expect, and when our healthcare systems were then prepared for a potential surge, the lockdowns subsequent to that, I think could no longer be adequately justified. What happened in the end was that they created many different problems. I’ll mention just two briefly. The first is a mental health crisis, which I wrote about last year in an article that I called The Other Pandemic, trying to draw attention to the very serious rising rates of depression, anxiety, substance use disorders, domestic violence, deliberate self harm, and most concerningly, suicide and drug overdose. We now know that last year saw, in the United States, 100,000 deaths by drug overdose, more than double what we had seen prior to the pandemic yearly when we all already had, as most folks are aware, an opioid crisis on our hands.
We took that opioid crisis and threw gasoline on that fire. The other thing that hap, the second thing that I’ll mention just briefly is that the lockdowns disproportionately affected the working class and the lower class. Whether this was intended or unintended, what some people have called the laptop class ended up benefiting from the lockdowns. Those who could work from home easily, maybe even found it more convenient. They were able to be home with their families and eat lunch with their kids and save money on gas and not have to sit in traffic. But the folks that had jobs that didn’t allow for that suffered greatly, either by taking a disproportionate risk in terms of their exposure to the early strains of COVID, which were more deadly than the newer strains like Omicron, or by having their businesses shut down. The COVID response ended up being a kind of class war.
We saw hundreds of thousands of businesses close in the United States. We saw the workers who couldn’t work from home disproportionately impacted by the early pandemic hospitalizations and deaths. We saw massive shift of wealth upward from the working class and the middle class to the top 1% of the 1% elite, mostly kind of tech giant companies and CEOs, that benefited massively from this lockdown arrangement. There’s a lot more that could be said about the lockdowns, but those are two harms that I think were inadequately examined. Now, when we have the opportunity to do a sort of postmortem, I think we have to take a careful accounting of those effects.
Dr. Kulvinder Kaur Gill:
Thank you for sharing your thoughts.
Dr. Asa Kasher:
Okay. I agree with the spirit of what Aaron has just said. I’d like to add two points. One of them is related to the way a democracy works. I mean, the core of democracy is a system of human rights. Human rights are related to liberties. Those liberties are not unrestricted. There are restrictions imposed on every liberty. I cannot enter the apartment of my neighbor without their permission. This is a restriction imposed on my freedom of movement. But under certain circumstances, those borders of our liberties seem to shift. The governments, at least in Israel, has used this situation in order to impose restrictions that cannot be really justified. I mean, in order to impose a certain restriction on the Liberty of a citizen in a democracy, you have to apply several tests successfully.
Let me mention just one of the measure that you take should be in some sense, optimal. If you impose a restriction, you have to show that a restriction which would be lighter won’t work. It won’t achieve the goals of the person. It should be something like a necessity. Now, lockdowns are so extreme in imposing the restriction. I mean, is that really necessary? I don’t have trust in anybody in the governmental circles, ministers, or politicians, or officials who are in charge of public health, that they can tell me the difference between the impact of restricting the movement from 1000 meters to 500 meters, I mean. That was something like waving hands. Then, there is another point I’d like to briefly mention.
At the background, when you start imposing new restrictions on liberties, usually it is done on the behalf of some general claim of emergency. We are now in an another type of situation. We are not in the ordinary manner of life. I mean, it’s an emergency. Under emergency conditions, you cannot behave as you behave regularly, but what exactly is the criterion for declaring the situation as an emergency? Let me give you just one example, without going too much into details of Israeli politics. I mean, the previous prime minister of Israel used the method of declaring the situation as an emergency, not for public health, but for his own political goals. There is just an emergency as a magic word and the Supreme Court wanted enter into discussions of what is emergency under such conditions, because they were told that it is an emergency. They take it very seriously, too seriously. There is a tool here that the system provides the politicians with to impose restrictions for political reasons, for economic reasons, for any kind of reason, that shouldn’t be regarded sufficient for imposing restrictions of the liberties of citizens in a democracy.
Dr. Kulvinder Kaur Gill:
Thank you, Dr. Kasher. Dr. Schabas.
Dr. Richard Schabas:
Well, I’m not an ethicist. I’m a practicing physician or I have been so I’m going to approach it from my perspective as a public health doctor because what I’ve seen in the last two years has really stood on its head. Everything that I based my practice and my colleagues based their practice on for the 35 years that I practiced public health. Things like… I know that I think Aaron referred the idea of a holistic approach to health. Health is more than just the absence of disease. It’s a positive state of physical, social, mental wellbeing. Well, health has become not all about an absence of disease. It’s become an obsession about only one disease. In public health, we were supposed to understand that what was really important was not medical care or not just medical care, but what we call the determinants of health.
We understood that things like education, employment, social connectiveness, those were the things that really have made us the healthiest people who’ve ever lived on the planet by just to have… They’re responsible for our fundamental state of health. Completely forgotten about. We’ve had education that we’ve thrown it under the bus. We’ve had children in Ontario, who’ve missed a whole year of in class education. We were always supposed to be grounded in social justice. We’ve already heard what’s happened with that and how we in fact have the fundamental social injustice of what’s happened with lockdown. Probably, the most important, in my opinion, the most important advance in the practice of medicine since I entered medical school 50 years ago has been the whole idea of evidence-based medicine.
We weren’t just supposed to accept things because they seemed like a good idea. We were supposed to know the difference between association and causality. We were supposed to understand all that. Well, it meant that sometimes we had to do things where we weren’t totally happy with the quality of the evidence. We were to be skeptical. We were to look back. We were to evaluate. We weren’t to accept it blindly, which of course is what’s happened. How did all this happen? I think two years ago, we uncritically accepted unreliable mathematical models that predicted this kind of microbiological apocalypse. The world panicked and embraced the whole series of draconian measures of dubious effectiveness and enormous, enormous cost. We did all this without having any clear idea of why we were doing it. What were our objectives?
Were we flattening the curve for a couple of weeks or we sort of morphed into this zero COVID mentality? Where we weren’t really clear what exactly we were trying to accomplish. Maybe worst of all is that we made it all work. We got people to buy into it by promoting fear. We’ve used fear as an agent of public policy, which is totally anathema to good risk communication, totally anathema to the principles of public health. Now, we’re at a situation where we’ve got these enormous sunk costs, sunk costs of reputation, of politics, that make it so hard to change, so hard for many people to have to admit that what they did was wrong, was misguided, led us essentially nowhere. Maybe even more difficult, we’ve got to come to grips with the huge level of fear. We see irrational fear, which breeds intolerance. It stifles discussion. It does a whole range of very, very bad things. We have to find a way of dialing that back if we’re going to move forward.
Dr. Kulvinder Kaur Gill:
Thank you, Dr. Schabas. Dr. Ponesse.
Dr. Julie Ponesse:
Lovely comments. Thank you to all of you. As you’re speaking, I’m thinking a little bit about some of the very basics of ethics and what it is that we look at. We certainly do look at goodness, what it means to do a good action or be a good person or live a good life. But I think, especially in the context of when something bad is happening, like a pandemic, or like the restrictions that we’ve been talking about that cause harm, we’re also looking at harm as well. It’s very well entrenched, I would say. A given almost as much as anything is a given within theoretical ethics and medical ethics literature, that harm assessment needs to be comprehensive, right? As many of you have suggested that harm is not just physical. The physical way of living a life is not the only constituent of a good life.
We have forgotten that we’ve had a kind of myopia on this kind of narrow singular focus on this one thing that could pose harm in one kind of way. That has had a lot of very deleterious effects, I think. One is that when we see the language and the narrative, I know we’re not talking about the vaccines right now, but whether it’s the vaccines or the lockdowns or the restrictions, the language always poses those in terms of physical risks to others. Risk is a hypothetical, and we gauge it using probability, right? But the cost of avoiding that risk or minimizing that risk is a loss of autonomy. When you mandate someone to get a vaccine, or you lock someone down on penalty of fines or imprisonment or social ostracization or whatever, the deterring carrot, so to speak, is that’s not a risk to a person’s autonomy.
That is a concrete harm. That is an actual harm. What’s hanging in the balance here is a possible threat to another person that’s purely physical in nature versus an actual harm to not just a person but to all of us. Right? I think our myopia has led us to fail to understand the true harms to us as persons that these restrictive measures are causing. That feeds very nicely into some of the mental health comments, especially Dr. Kheriaty had made. We saw McMaster University, which is in Hamilton, Ontario, and actually has been a leader in evidence-based medicine, not just in Canada, but globally, I think. They saw a 300% increase in the pediatrics in their emergency department last fall, suicidal behavior and suicides. Again, our myopia has prevented us from a more comprehensive assessment of harm.
When we think about some of the disproportionate harms that these public health measures are causing… A sort of simple example of disproportionate harms, if you think about the thalidomide case, if you prescribe a sleeping pill in order to prevent the harm of sleeplessness, but it causes something like birth defects in offspring, that is a far greater… Right? It’s kind of disproportionate harm. I think we’re seeing that now, that many of our COVID policies are causing these disproportionate harms across the spectrum of health that is not just physical but mental as well. It was mentioned earlier that we’re seeing different… A kind stratification in classes who are disproportionately affected by these lockdowns. I think that’s also true across the ages because people in their sort of middle age, if you’re sort of 20 to 50 or so, and you have… Maybe you’re in the workforce or you’re in school, a post-secondary school.
The point is, that you have social connections, or it’s easier to maintain the ones you have or find new ones. But people at opposite ends of that age spectrum, the elderly who are… We’ve seen the harms that they’ve suffered, where they are just experiencing terrible loneliness and abandonment in our retirement facilities. And then we’re talking about children. I think we’re just starting to become aware of the psychological harms of masking and restricting their social connection. We know how it important it is for them to see faces, to develop physical cues or psychological cues. I have a 21 month old, she was born a month after the World Health Organization declared the pandemic. I make a very concerted effort to give her a normal life without masked people and things like that, but it’s easier for some of us than others.
It’s more possible for those of us who know the harms, who have the educational background to understand those harms, but that’s not true for everyone. I think to think that these psychological harms are reversible is naive and not based in the evidence. I’m not sure we’re going to know for a very long time the protracted… The effects of these protracted socially limiting measures on our children. I suspect many of them will be irreversible and they will start coming to light when those children become adolescents and when they become parents. We’ve really saddled ourselves with a very deep, psychological and social problem, I think.
Dr. Kulvinder Kaur Gill:
Mm-hmm (affirmative) Thank you-
Dr. Richard Schabas:
Yeah. I’d like to interject. I hope you’re wrong about the how deep these scars are at. I hope you’re wrong, but I fear you may not be. I mean, I know people say, “Oh, we had to do these things because it was prudent. It was cautious.” It wasn’t. It was wildly reckless. It remains wildly reckless to compromise things like education, like social connectiveness, that we know are so important. To throw them out the window without strong evidence is, I think, a wildly reckless thing to do.
Dr. Kulvinder Kaur Gill:
Mm-hmm (affirmative) Many of you have mentioned the impact of these policies on children. We know that children have borne tremendous harms from governments’ imposed policies, from school closures and mask mandates, which interestingly have been imposed by some jurisdictions in the Western world, but have not been by others. Likewise, the COVID vaccine has been recommended for children in some jurisdictions, but then not in others. Where is the ethical reasoning in the spectrum of these government policies that we’re seeing in these various nations for the same thing, but coming out with very polar opposites in terms of policies?
Dr. Aaron Kheriaty:
I guess we could begin with the issue of childhood vaccination. I’ve been involved in some policy making surrounding the vaccines when I was at the University of California. I helped develop the vaccine allocation policy. At the beginning of the vaccine rollout, there were ethical questions about when the demand for the vaccines exceeded the supply of vaccines in the first couple of months, who should get them first? How should they be allocated justly and fairly? To try to do the most good with what we had. I did that with the university. I also was on the Orange County vaccine task force locally here doing some of the same work in the county where I live.
When it came time to thinking about these vaccines in children, I was very concerned and alarmed that there was almost no discussion of the ethics, not only of vaccinating children against a disease that they are not at risk of bad outcomes for, but even of testing these vaccines on children. Here’s what I mean by that. We know that a very, very small number of children have died with COVID. Some of those may have even died of COVID, but if you examine those cases, you see that those children all also had co-occurring medical conditions that were very, very severe. There’s no evidence that healthy children are at risk of bad outcomes from COVID. That’s been one of the few silver linings in this pandemic is that healthy children really are not harmed by COVID.
So to take a population of healthy children and subject them to an experiment with a vaccine that is not going to benefit them, because their immunity is already so good against this virus, it’s virtually impossible to improve it with any measures, and subject them to a vaccine that we know, and we can argue about what the risks are with these COVID vaccines and there’s arguments about how rare or perhaps not so rare, some of the adverse effects of the vaccine related injuries are. But regardless of where you come down on those debates, everyone, every honest person will acknowledge that there are risks with these vaccines and there have been serious injuries associated with them and even deaths associated with them. So to subject those kids to risks where there’s no benefit to them is to instrumentalize them.
It’s a form really, of what we call non-therapeutic research. Therapeutic research is research where the research subject could potentially benefit from the intervention. But non-therapeutic research is a research where the individual is not going to benefit other than maybe some ancillary psychological benefit, that I feel like I’m helping humankind by taking part in in this experiment to gain knowledge. But aside from that, a competent adult can consent to engage in non-therapeutic research as an act of generosity, for the benefit of humankind. Children, as Paul Ramsey and other bio-ethicists have argued, should not be subjected to non-therapeutic research, because that involves using them as means to another end. The other argument that was deployed, that I did not at all find compelling, was that even if children are not going to benefit from the vaccine, we’re justified in vaccinating them regardless, because that may help slow the spread of the virus and that may help protect older people who are at risk of bad outcomes.
And I think that justification fails on two counts, one empirical, and the other ethical. Empirically, we know that children are not responsible for the spread of this virus. They carry very, very low viral loads, their immune systems take care of the infections very quickly, and in almost every case where we see transmission in schools, it’s adults transmitting the virus to children, not the other way around. We also know that these vaccines do not stop infection and transmission. They do not offer what we call sterilizing immunity. That’s been acknowledged by the CDC, it’s very well known now, it’s obvious from the cases during Omicron, that the vaccines are very leaky. They do not prevent infection and transmission. So that sort of argument from social solidarity is weakened to the point I think of being irrelevant when it comes to these particular vaccines. We have to fall back on the risks and benefits to the recipient, a sort of traditional clinical bedside medical ethics.
But even if we had a sterilizing vaccine, I think this argument should still trouble us. Because what it amounts to, is using children to shield adults from harm in a way that could potentially put the children at some degree of risk. And I think no sane society should find that morally acceptable. Adults are responsible for shielding children from harm. We are responsible for making sacrifices for our children and our grandchildren and the next generation. But children being vulnerable as they are, and entirely dependent upon their parents and upon the adults in the society to keep them safe and to have their best interest in mind, I think should never be instrumentalized in the way that they have been with the campaign for mass vaccination of healthy children during COVID,
Dr. Asa Kasher:
I’d like to raise an additional issue concerning the way that governments create and then implement Policies. There is the danger of the government of the so-called common sense. There are ministers or politicians, make a decision concerning what should be regarded best for the population. How are they going to do it? Okay. They listen to some experts in public health or in epidemiology or whatever. They listen to them. They’re not committed to accept their views or accept the recommendations. Now they’re not even committed to listen to other experts in human medicine, in epidemiology or in public health. So they choose, who knows how, a certain group of experts. They listen to their recommendations and then they do whatever they want. Now doing whatever they want means making decisions primarily, not related to public health, but to a variety of other considerations. Like economic considerations or political considerations or whatever.
Now, to my mind, this shows deep flaw in the way democracies work, okay. We have a problem. We want to solve it. We have experts in the field of solutions of those problems, but who makes the decisions? Not those experts, but people who just have some common sense and authority. Now they bring into the picture, additional considerations, which is fine. However, their decisions concerning which type of considerations should have the upper hand, is not clear. It’s not transparent. It’s not self evident. It is made in those closed chambers by people who cannot usually be trusted for making such complicated decisions. So the balance between expertise at the one hand and political common sense at the other hand, is something that we get used to, but I think it’s wrong. And the pandemia and the corrupt, and the whole story of the present pandemia shows that there is something fundamentally wrong in the way people make decisions concerning the life of the whole population.
Dr. Richard Schabas:
Yeah. I agree with what both my colleagues said. I think Aaron made the points very strongly about how immunizing children to protect the elderly is ethically problematic at its root, with the additional problem, of course, that it actually doesn’t work. It’s not dissimilar to the situation we have with influenza immunization, which we have for 20 years promoted among children in Ontario, not for their benefit, but for the benefit of the elderly. And by the way, also, it doesn’t work to protect the elderly. So why are we doing this? Well, I think it’s partly because of fear. We have this element of fear. Many parents are worried about their children. They’ve been told that children are at risk. They’ve been told that the number of children admitted to hospital in Ontario in the last few weeks has been going through the roof.
They’re not told that that’s because people are admitted with other conditions that happen to have a positive COVID test. They’re frightened by that. But I think it’s also the political commitment, the political investment. They’ve been looking for a way out of there. And the politicians are all in. Went all in on the vaccines a year ago, when they were first putting the use and in many ways, the vaccines have been wonderful. They played a huge role in reducing our serious illness and our mortality, but it doesn’t give them the exit from COVID that they were hoping for because it doesn’t stop transmission. And again, they’ve got this sunk cost in the vaccines, they’ve oversold the vaccines just as they oversold things like masks. And once they’ve done it, once they’ve committed themselves to it, very hard for them to back down.
Dr. Kulvinder Kaur Gill:
Thank you, Dr. Schabas.
Dr. Julie Ponesse:
So many deep, fruitful comments there. Thank you to everybody that I think it’s very comprehensive and on point. A couple things to add. One is that, I think part of the narrative to get children to vaccinate themselves, even if we realize, they realize it’s not for their own good, is so that we teach children that it’s important to do good for others. I see that a lot in messaging. And it sounds like a great idea, right? It sounds like, well, shouldn’t we be teaching children that it’s important to do good things for others. Yes. In some sense. But, the devil is in the details as they often say, right? And I think it’s hard for children to understand the context and the concept of goodness in this case, whether or not getting vaccinated actually would benefit others, and if so, in what sense and what possible harms they can do to themselves.
And so, I think that we’re almost building a kind of moral pedagogy into this narrative in the pediatric population. I’m part of a group of teens called Teens For Freedom. It’s very interesting to hear how they talk about these things. It says teens, but some of them are actually quite a bit younger than that. And they all say the same thing. They all say they’re told, I’m supposed to do this to help other people. I’m a good person If I get vaccinated, I’m a good person if I wear my mask and if I’m not, then I’m bad. And there’s no mention as far as they’re concerned and I think this is an accurate perception because I don’t see this as part of the narrative, that children have the right to consent. I know that it is part of the narrative that they don’t need consent, but we don’t have a discussion of what consent really is. And we’ve definitely under highlighted the informational component of that.
And I think the narrative, when it comes to vaccination for children, unfortunately piggybacks on some very basic things they already accept that you’re taught as a child. This collectivist group mentality, is very much a part of what it is to be in kindergarten or to be in preschool. It’s to get along with the group and it’s to follow the rules. It’s everybody put your shoes on, everybody clean up your mess after lunch. And those are not bad rules, but if you’re targeted messaging in the pediatric population is again, sort of piggybacking on these things they already take for granted, it’s a bit like a Trojan horse, right? They’re not going to think there’s anything wrong with this, because it sounds just like all of the other very reasonable things they’re asked to do for each other on a daily basis.
So I think the language is very problematic. Another important aspect of consent for children and this is tapping into some of the medical concerns about the vaccines. There have been concerns about infertility down the line and without weighing in here, whether or not those concerns are legitimate or what all of the sciences that supports it. I think until we know that the vaccines are safe in the sense that they won’t cause problems with fertility down the line, that’s something that needs to be a robust part of children giving consent, because I think what’s especially important about that is that the younger a person is, the less likely he or she is to think infertility is a problem that they could have, be that this is a very complicated issue that has been handled in a very streamlined, simplified way to great harm for our children, I think.
Dr. Kulvinder Kaur Gill:
Prior to the past two years, informed consent was a cornerstone of medical ethics and it was required, it’s still legally required, ethically required, but there seems to be something happening, where it’s being violated and informed consent is meant to be for all medical interventions and without any form of coercion, without any form of restriction, with free will. But with the mandates where we see essential healthcare workers, our first responders, truckers, many other essential workers being forced to choose between their job, their livelihoods, being able to support their families and to put food on the table or have a choice in the medical intervention for their bodily autonomy.
Now much of these policies have had very detrimental downstream effects, where we’ve seen because of the fired essential healthcare workers, we’re seeing shortages of healthcare staff leading to OR closures and surgery cancellations. In some parts of the world, including Canada, we have had emergency room closures. People sounding the alarm in terms of supply chain issues that will arise from the mandates imposed on the truck drivers. Now, what has happened to informed consent and bodily autonomy? And where are the ethics in imposing such employment mandates, which are unprecedented? And why are we seeing such impositions in certain jurisdictions, while other jurisdictions are still upholding informed consent?
Dr. Aaron Kheriaty:
So I’ll begin. Maybe just with a little personal story about my own journey, which in some respects parallels what has happened to Julie. Back in July, I published a piece in the Wall Street Journal, arguing the university vaccine mandates were unethical. The University of California, where I worked really my entire career, for 15 years in the School of Medicine and directed their Medical Ethics program, imposed a vaccine mandate, and I decided to challenge that vaccine mandate in federal court on behalf of people like me that had infection induced immunity, sometimes called natural immunity. Those who had recovered from COVID. And we had empirical evidence at that point, which has only grown in the gap between infection immunity and vaccine immunity, has only grown in the months since then, but already by that point, we could see that protection against COVID from having recovered from an infection was superior to what you got with the vaccine.
So I argued that it was discriminatory and violated our constitutional rights under the 14th amendment of the US constitution to not be allowed on campus, when those who received a less efficacious vaccine were allowed to go to work. A few months after I filed that case, my university did fire me for non-compliance with that vaccine mandate. And so I’ve been wondering, what happened to informed consent as well. And again, I think the arguments in favor of mandates that could, or should override informed consent, have been extraordinarily weak, they rest on faulty assumptions about what these vaccines can and cannot do. And people often in the United States defer to a 1905 Supreme court case precedent to uphold these mandates or to argue in court that these mandates should be upheld. And this was a case called Jacobson V Massachusetts, where the Supreme court of the United States sided with the city of Boston in upholding the city’s ability to levy a $5 fine against anyone who refused a smallpox vaccine during a smallpox epidemic in the city.
Keeping in mind that smallpox is far more deadly than COVID, that it affected young and old alike, pretty indiscriminately, and a $5 fine, I did the math, adjusted for inflation, would be about $155 fine today in US dollars. I think something that anyone who’s been fired from their job would gladly have paid in order to be able to exercise their right of informed refusal. So we were never offered alternatives, whether it be working from home, whether it be taking other measures to reduce the risk. Of course, all these mandates indiscriminately ignored biological and empirical realities like natural immunity, which is sort of the crux of the case that I’m still fighting in federal court to challenge that mandate. So I think there are all kinds of things wrong with these mandates, and the legal justification, and the precedent that is referred to is actually very, very modest and in no way I think, justifies the draconian measures that have been taken in the pandemic in the United States, that have supposedly rested upon that legal justification.
A legal justification that was prior to new developments in law surrounding bodily autonomy, surrounding what we call tiered levels of scrutiny, higher levels of scrutiny. If one’s bodily or constitutional rights are going to be infringed upon. So there’s been a development of legal doctrine since that modest case precedent in 1905 that I think has to be brought to bear on these questions when it comes to examining them legally and challenging some of these vaccine mandates in the realm of law. And I know that in Canada and Israel, the legal precedents and the court systems are going to work somewhat differently.
But I think these are all countries that whether it’s their constitution or their charter of rights, should have robust protections against violating person’s conscience or their bodily integrity, or their right to informed consent, which Kulvinder as you mentioned, it’s a bedrock principle of medical ethics, going back to the Nuremberg code, the declaration of Helsinki, that was published by the World Medical Association that expanded upon that doctrine of informed consent in the United States, the Belmont report that was commissioned in the 1970s, which became the basis for what we call the common rule, the federal law governing research on human subjects that then influenced medical ethics at the bedside.
There’s a whole enormous and very important body of ethical and legal doctrines internationally, and in my own country certainly, that should have provided a strong bulwark against these kinds of infringements on the right of competent adults, to exercise informed consent, and for reasons that are quite beyond me, it seems that most of those norms have been abandoned with very little debate and very little public discussion or scrutiny or checks and balances operating on the system.
Dr. Asa Kasher:
Okay. Before we look at coercion, I think let’s look at the ordinary event. During the last two years, I went with my wife four times to get the vaccination. Okay. So the event of being administered the vaccination took the following form. We came, we showed our ID cards, they found our names on the computer, and then they put the needle into our hands. Nobody asked us whether there is a consent, because obviously if we came to get a vaccination, then we consented. But what about the informed part of it? What about being informed? Nobody talked to us. Nobody, not because they don’t treat us well, they treated us perfectly well, but they didn’t think that they have to inform us. They were not in a position to ask for our informed consent, because an informed consent rests on something that they should provide us with, namely, the balance of benefits and risks.
Now, I don’t know what is the balance. They should know the medical stuff. They should know, what is the balance of benefits and risks. And they didn’t say a word about it. They didn’t say a word about it, not only when we encountered them at a vaccination procedure, but in general, say in the public announcements of the ministry of health, or anywhere else on similar platforms. Now, there is a, so first of all, let us make the point that the medical staff shoulders part of the responsibility for the death of informed consent. Because they were willing to give us the treatment of vaccination without talking to us, without informing us anything. Now, there is another ingredient of the whole, another component of the whole situation, namely, that I’m not sure that they themselves know what is the balance.
Not the only those nurses who administer did, but they’re people in charge of them. I mean, if you look at the agreements signed by Pfizer and the government of Israel. Now, when you look at them, you cannot read all of them. You can read just parts of them. They hide some parts of it, of the agreement. Now, why are parts of the agreement hidden from the citizens? So they say, okay, there are all kinds of commercial from economic transactions between the government and the company. Okay, Let assume this is correct. But when you look at the pages where something was crossed out, there is no explanation on earth that would convince me that some commercial issue was hidden there and not something else. What exactly do they hide? If they hide some parts of the whole arrangement, then they’re not in a position to convince us that the balance is the right one.
So there is something like throwing away the whole idea of informed consent. Moreover, there is another issue here. What the vaccination is being administered to us on grants of something like a permit issued by the FDA, not an approval, a permit. Now, okay. Now when it’s a permit, then one cannot say that what they do, what Pfizer and the government of Israel are doing is something like having an experiment done on the population of Israel. It’s not really an experiment, but it’s not something that is ordinary administration of medical means. It’s not an ordinary administration of some medical treatment.
It means that they don’t know a lot. And they should have asked us for informed consent, they should have told us that they don’t know a lot about certain aspects of the whole situation and allowed us to make decisions. Under such circumstances of partial information, how should one act? And people are different from each other concerning their relationship towards acting under partial information and the conditions where some crucial parts of the situation are not known to them. So I think that the basic aspects, basic ideas of benefit ethics, like informed consent , and like how to conduct something, which is between an experiment and ordinary treatment. Those aspects of medical ethics were totally disregarded.
And it’s mind boggling when you think of it. Why have we reached such a situation where not the government that I don’t expect too much when medical ethics is not the consideration, I don’t expect too much from them, but the medical profession, there are millions of cases of administering the vaccination to Israeli citizens, which means that millions of events of a person meeting a person who acts within the framework of a medical profession, a doctor, or a nurse or something like that. What happened to them? What happened to them all? There is no simple answer.
Dr. Richard Schabas:
Let me begin just by kind of observing the irony that the public health in the past has always argued, as I said about the determinants of health, and one of the key determinants of health was supposed to be employment. And we always made the argument that unemployment was bad for health. Unemployment actually kills people. And here’s the irony that to promote this one public health agenda we’re prepared to sacrifice something which is sort of deeply rooted in our fundamental principles. And we do it with without a second thought. It’s quite astonishing. I’ve seen a variety of arguments put forward in support of vaccine mandates in general. And I think it’s important to realize how fragile those arguments are. There’s the one that it protects us all because it reduces transmission of disease.
And that would be a coherent argument if it were true. But as we know now, sadly, the vaccines with Omicron, really have little or no impact on infection and on disease transmission. So that’s not a coherent reason for the vaccine mandates. The second rationale is that they reduce the burden on our healthcare system and on our intensive care units. And I think there is some coherence at least to that argument, because the vaccine have been highly effective at reducing serious illness and the risk if you do get infected that you’ll end up in an ICU, for example. But the problems with that argument are, first of all, that doesn’t apply across the board. That argument can be used for people who are at some material risk of ending up at an ICU if infected, but in Ontario, our vaccine mandates begin at age 12 and I’m sorry, healthy 12 year olds have no risk of ending up in ICU, no meaningful risk of ending up in ICU.
So to implement that part of it properly would be difficult and discriminatory. The third argument is that somehow it’s going to generally encourage people to be immunized. That if we put pressure of this kind on people to be immunized, if we use coercive measures that will increase our immunization rates. And I’m not sure that’s true. In fact, I’m becoming very suspicious that it may have had exactly the opposite effect. And by way of example, we have a law in Ontario called the Immunization of School Pupils Act. It’s been around for almost 40 years. And people think it’s a mandatory immunization act that requires you to have certain vaccines to go to school. Actually, it isn’t. What it requires is that you have to present a record of immunization, or you have to have a valid consent and a valid consent can be a philosophical consent. Basically, all parents have to do is to swear a statement saying that they’re philosophically opposed to immunization.
And unless there happens to be one of these extraordinarily rare outbreaks of a vaccine preventable disease in school, something that almost never happens, there are essentially no consequences to parents doing that. But the reality is that when you force parents to either get their children immunized, when you put pressure on them to either get their children immunized, or to get the philosophical consent, fewer than 2% of Ontario parents, going back 40 years, have in fact gone the philosophical exemption route. So there’s no deep seated anti-vaccine sentiment in Ontario. I know we’ve demonized the anti-vaxers for years, public health has been screaming about how anti-vaccine sentiment was increasing, but there’s really no objective evidence for that.
But what we have done through this very heavy handed approach, this the government’s going to make you get immunized or else, people who were understandably reluctant, they were concerned about safety, they had all kinds of concerns, which I think we needed to be sympathetic to even if they were wrong, even if they’re in a group where in fact the benefits outweigh the risks and they shouldn’t. We certainly should be encouraging immunization. By turning it into a matter of coercion, I think what we’ve done is we’ve walked in vaccine resistance and I think that’s going to be very hard to undo, because it’s not so much about the vaccines anymore. It’s much more about government coercion.
Dr. Julie Ponesse:
Whenever I feel like I’m getting very entrenched on one side of a debate. I try to run through almost like it’s like doing your warmup exercises for the day. I’m trying to run through what’s in the mind of the person on the other side of things. And I find myself doing that every day now and I don’t know if people on the other side are doing that, but I’m trying very hard. Because I think there must be a bit of a strange kind of cognitive dissonance happening. I think very early on with the employment mandates, especially, and to tie this into Dr. Kheriaty’s mention of the Jacobson versus Massachusetts case, the analogy between the COVID vaccines and the smallpox vaccine is still made by very intelligent, well researched people now to this day. And I think that’s because there was, and still is sort of a lingering sense that the COVID vaccines are sterilizing just like all of the other vaccines for illnesses that are not common in the population anymore.
And if that’s what you believe that as Dr. Schabas has said that there’s a certain kind of that makes some kind of sense. And as we’re dispensing with this transmission argument and realizing though, we might not always know the terminology, but realizing that the COVID vaccines are not sterilizing in that way, then we need a new moral argument for imposing the mandates. And then that I think we’re borrowing from this severity of illness argument and importing it into a public health context and mandating it. But if all we have left is the argument that you need to be vaccinated to maintain your employment in order to reduce severe illness.
Then I think we have a new kind of question, because the question now is it’s not that employees, it’s not that we’re concerned that employees are going to be spreading the virus at work it’s that we’re concerned, because they already know they do, it’s that we’re concerned that if they get sick, they will get very sick. And that will be a burden on the healthcare system. And it will be bad for them presumably, but those are two different kinds of arguments, right? And so if we’re mandating employees to get vaccinated for their own sake, so that they don’t get terribly ill, then that’s not a matter of public health anymore. That’s a matter of a person’s own choice. And the risk assessments that different people with different personality types, different stages of life, with different family commitments and things like that, I think are fully entitled to make in order to be determining in their own life.
And then the only argument that’s left then is that, well, when you have socialized medicine, as we do in Canada and people getting very ill does pose a burden to the healthcare, an extra burden, arguably a preventable burden on the healthcare system. Maybe that becomes a public health issue, but there are a lot of steps there that require evidence. And I don’t think we’ve, we’ve seen it, right. So I think it’s so, so important that we parse the issues that we understand and everybody’s articulated that so well, we understand the nature of these vaccines, what they can do in a best case scenario and whether or not it’s paternalistic to mandate that for employment or is it a public health issue? You know, we are seeing now because of the strain on the healthcare system and other sectors of employment, them recalling vaccinated persons who have tested positive for COVID, but not rehiring terminated unvaccinated persons. And that really shows the double standard I think we have. And this kind of discrimination against innate healthy biological characteristics.
I think we’re saddling ourselves with this idea that to be artificially made immune, to be vaccinated is better than to be naturally immune. And there’s a lot of baggage that comes along with that. And I think that’s going to affect how, not just affect, but infect how we think about health more generally, because it’s pushing, I think, or at least motivating a more artificial means of obtaining and maintaining health and discrediting a lot of the contributing factors to immunity that we have not seen as part of the pandemic discussion.
Dr. Aaron Kheriaty:
And I would add to that with new variants and with time as we’ve seen vaccine efficacy decline, and by the way, efficacy against infection for these vaccines starts to decline at about four months, which is why I think Pfizer and Moderna designed their trials to be three months long. Say whatever you want about big pharma, they’re very good and they know how to do clinical trials. And they design them with a particular outcomes in mind. It starts to decline at four months. By six months, it’s below 50%, which is the threshold necessary for FDA approval. And against Omicron there was a pre-print that came out a couple of weeks ago, suggesting basically zero efficacy against infection from a two dose regimen. Very questionable efficacy, low 50% for a third dose, which there’s a lot of questions too, about how long that’s going to last since the duration of efficacy from the two dose regimes was so short.
So in fact, there are people raising concerns about what’s called negative vaccine efficacy against infection. There’s four or five different plausible hypotheses about how this might work, but we’re seeing now in Ontario, actually higher rates of infections among the vaccinated than among the unvaccinated. And I’ll say that again, in case people think that sounded confusing. Higher rates of infections among the vaccinated and among the unvaccinated. Not just total numbers. We were seeing that for a couple of months, the total numbers of new cases were higher among the vaccinated. But if you look at cases per 100,000, those lines crossed, and now there are more cases per 100,000 among the vaccinated than among the unvaccinated. The reasons for this negative efficacy, which we’re also seeing in Israel and in several other highly vaccinated countries are matter of dispute, is this so-called original antigenic sin, antibody dependent enhancement, or some other combination of factors that may be accounting for this.
But that’s a very concerning empirical trend that these vaccine mandates are ignoring. The efficacy against severe illness and hospitalization has also declined, though not as steeply, as the efficacy against infection, but we are to the point now where a very significant number of hospitalizations. And again, Ontario is gathering for good data on this. It’s one of the upsides of your healthcare system. But last I checked, this was a few weeks ago. I think 40% of the hospitalizations were people that were fully vaccinated and had very significant percentage of hospitalizations were individuals that had a three dose regimen. So this whole notion that this remains a quote unquote pandemic of the unvaccinated, if it was true, it was only true during the few months after vaccine rollout, when we saw that kind of peak vaccine efficacy.
But if you continue to follow the data out up through the Omicron way, you see that’s not the case anymore. One of the things that concerns me is this failure to keep up with the emerging data as we go. And sort of, we talked about the sunk costs. We public health authorities or politicians are doubling down on policies that were misguided in the beginning and clearly failing now on the grounds of the outcomes that they’re producing. The final point I want to make about this is the problems with transparency.
So Dr. Kasher mentioned the issue of informed consent when you’re actually at the site where you get your vaccine. In the United States, when you get a vaccine or a drug, you can, you can take a look at what’s called the package insert. This is the form that’s created by the FDA. When the drug is fully authorized, that has information about risks, benefits, side effects, contraindications, drug-drug interactions. If you take out the package insert for one of these vaccines, you’ll see that it is blank. We don’t have one yet because all of the vaccines available, at least in the United States are only authorized under what we call the emergency use authorization. Now, the day that the Pfizer vaccine was authorized under US federal law, the FDA was required to release the clinical trials data on which that authorization was based. They didn’t do that. So I organized a group of other scientists and doctors to file what we call Freedom of Information Act request to get that information.
What happened with that Freedom of Information Act request is that the FDA realized that under federal law, they couldn’t withhold that data, but they tried to slow walk it. They came back and said, we’ll give you 500 pages a month, which if you do the math, would’ve taken 75 years to get all the data. Fortunately, the judge was wise to their tricks and said, no, you have eight months to roll it out. Pfizer intervened and offered to help the FDA to redact the data before it’s released. And amazingly the department of justice lawyers, the federal lawyers that were representing the FDA in court, agreed with Pfizer and said, “We want the company’s help in redacting the data to get it out on this timeframe.” But I think clearly what we see here is a public agency that is supposed to be regulating this industry, which everyone knows is their aim is profit.
We can hardly fault a corporation for being motivated by profits, but when the regulatory agencies are acting in the interests of the corporation, rather than the interests of transparency, which is a basic ethical principle of public health, we’ve got a situation in which the possibility of informed consent is severely compromised because we cannot get the basic data that the FDA rested the authorization on. And by the way, this data that they wanted, 75 years to release, it only took them 108 days to review that very same data to give the authorization. So that’s just I think one example of the ways in which many of our public health agencies are not act acting in the interests of in this case, the American people, but also since many other countries look to the FDA and the CDC for guidance, it’s having effects internationally as well.
Dr. Richard Schabas:
I want to come back to the point too, that I know Julie spoke about this, about protecting the healthcare system and discrimination against people for not being immunized. If we applied that same standard, if we accepted that as a standard, we probably should be applying it to people like smokers as well. I’ve never seen a number on what proportion of ICU beds in Canada are at any given time as a result of tobacco induced disease, but it’s probably not very different than the 20 or 25% that are now occupied by COVID patients at the peak of our Omicron wave. And of course, it goes on day in and day out. So we don’t, we don’t let smokers smoke in restaurants, but to be consistent, we shouldn’t let them into restaurants. And we shouldn’t let them have jobs because they put an unreasonable burden on our healthcare system. That’s a logic that’s going to take you a lot of very ugly places I think
Dr. Kulvinder Kaur Gill:
One thing I would like to dwell further into, which a lot of you have touched upon, is basically all of the ethical doctrines that exist, that were supposed to be guiding us through all of these very difficult decisions. And as Dr Kasher mentioned, it’s very unclear why millions of healthcare professionals in Israel and in other parts of the world seem to have abandoned many of these ethical doctrines and principles. And as Dr. Kheriaty had mentioned, we have the UN declaration of human rights. We have the Hippocratic Oath, we have the Nuremberg Code, we have the UN declaration of bioethics and human rights, we have the Declaration of Geneva. There are many historical doctrines which are still upheld today. Which are part of our medical ethics, which are part of our scientific ethics, our public health ethics. But for some reason, which is unclear, it seems to be to all of us, has been completely abandoned.
And then as Dr. Schabas had mentioned, we’re seeing these very unprecedented discussions happening about denial of essential healthcare based on an arbitrary vaccination status definition. We are seeing discussions about quote unquote, social justice triage. We are seeing discussions about denial in terms of participation in society. Based on government’s arbitrary definitions. We are seeing an abandonment of medical privacy, where as Dr. Ponesse had mentioned with this collective attitude, we’re seeing in some circles a discussion shifting from the duty to the patient to a duty to society, which undermines the core premise of the sanctity of the doctor-patient relationship and that being protected from any interference from the state.
And we’re seeing an entire shift in paradigm in terms of core foundational principles of medical ethics. And what I’m hoping you can all provide insight about is what are the historical relevance of these doctrines? What initially happened that created them? Why were they created? Why are they so important? And now with them being violated, is this violation, do you think temporary, do you think this will be something that will be restored? If it isn’t restored, what are the implications? And how do we ensure that they are restored and in a manner that happens as soon as possible.
Dr. Julie Ponesse:
I think the question you ask is a really interesting one. Why did we, what was the genesis of these documents to begin with? But before we get to that, could I weigh in on the question, why are we so quick to overlook or disfavor autonomy for the sake of protection and harm prevention and things like that? And I think about this a lot. I have two thoughts. I’m not deeply wed to either, but I’ll put them on the table and maybe others can weigh in. One thought I have is that harm prevention is conceptually very simple, very easy to understand. You don’t want your child to burn her hand on the stove, you tell her don’t touch the stove. And I know that sounds very simple. But if you’re trying to build a public messaging system around an idea, harm prevention is a pretty simple one.
Also, we might think, well, medical professionals they don’t necessarily need something conceptually simple. They should be able to transcend that and see through simplicity to some of its complexities and some of the consequences of thinking too simply. But harm prevention also taps into something. I talked earlier about collectivism sort of piggybacking on things that children already believe. Well, I think harm prevention taps into something that health professionals already believe in deeply, which is nonmaleficence or this core principle that has this Hippocratic connection. And this idea that one should first not do harm, but there’s a difference between nonmaleficence, which is first do no harm and preventing harm, right? Those are different. It’s different to say that a person should not engage in an action which produces harm. And then to say that it’s important that we do everything possible, stop society from functioning in order to prevent some kind of harm.
And I think we’re seeing this in these discussions of the precautionary principle, because people on the anti narrative side will say, “Well, hold on, let’s be very careful about lockdowns, masking, vaccinations strategy, because we want to be more cautious and being cautious sort of requires us to refrain from implementing these things until we’re sure we can proceed with caution.” But I think the precautionary principle has also been adopted by the people on the pro narrative side to say, “Well, hold on, we want to prevent the harm of infection and prevent the harms that come from COVID therefore let’s do everything possible. Let’s mask let’s lock down. Let’s vaccinate the world in order to prevent the harm of COVID.” But again, I think that’s conflating these two issues, right? Is our moral obligation not to do harm or is it to prevent harm as healthcare professionals? And I won’t maybe answer that question now, but I think it’s an important distinction to make.
Dr. Asa Kasher:
I’d like to start discussing it with you. I think let’s call a spade, a spade, okay. There is a crude perception of the danger of the harm involved. If you look at what is under consideration, you get people describing it in terms which are professionally unacceptable. I’ll give you an example. Our prime minister said that people who are not vaccinated and refuse to be vaccinated are similar to a terrorist who holds a sub machine gun and just fires fire the bullets around and kills people in the open, I mean, easily and clearly, and deliberately. That was his perception of the danger that stems from a person who has not been vaccinated. But this is wrong. This is so wrong. I mean, and it’s interesting to think about how come that he has used such a crude example.
Now people are not very strong in using probabilistic thinking. So probability’s you multiply them. So if you have a probability of 5% and then another probability of 5% and another probability of 5%, you get something which so small that in daily life, we ignore it. I mean, the danger that lurks in the bushes, when I enter my car in order it to ride it, the danger is larger. The probability of being involved in a car accident is larger than that probability. But this is not the way people think they think in crude analogies and they are unable to take into account probabilities. So this is a person who’s not been vaccinated. He’s dangerous. How dangerous? 100% dangerous. How often is he dangerous? All the time. What should we do about him?.
And then there is another argument that tries to support that common sensical view which suffers from the same syndromes. Now we are always being told that hospitals are going to crush. I mean, if people are not getting vaccinated, then the whole health system is going to collapse. We’re not going to have sufficient beds in regular departments, in ICU departments anywhere. I mean, okay. It’s all going to be beyond our capacities. Now at the worst condition in Israel, we were orders of magnitude away from collapsing. We have say 3000 beds, in which you can administer the treatment to a certain kind of people. We were in the hundreds, not in the thousands. So the reason another common sensical picture, there going to be many people who require treatment. We don’t have sufficiently many beds in the medical centers. So it’s going to collapse. So we must do something against those people.
And what can we do against them? They’re so dangerous. Dangerous both in terms of infection and in terms of the future of medical centers. Coerce them. Force them. And how can you force them to get vaccinated? By all the mandates of all the restrictions imposed on employment and university campuses and on shops and malls and all the other places where people have to go in order to maintain their ordinary way of life.
Dr. Aaron Kheriaty:
Why aren’t more ethicists standing up and speaking up and raising objections is a very good question. I would suggest part of the answer is look at what happened to Professor Ponesse and Dr. Kheriaty, when they tried to do that. So it doesn’t take too many examples of that before others learn that discussion debate on this topic is not going to be tolerated and is not open for conversation and then you can back up and say, “Well, okay, why did our institutions behave in this way?” And a simple answers is that, there’s just an enormous amount of money at stake. These vaccines have been a hundred billion dollar industry so far, why didn’t the CDC recognize natural immunity because over half of all Americans clearly have natural immunity now. You’re cutting a hundred billion dollars in half, that’s a lot of money at stake if all those people don’t require vaccination. The research universities that employ medical ethicists, University of California, where I worked for example, have a lot of grant funding coming in for clinical trials from pharmaceutical industries. My own industry had many millions of dollars from our retirement fund invested in Pfizer.
There are corporate ties between these public institutions and private corporations that run very, very deep. There’s even ties between the corporations and the governmental agencies so the NIH, the National Institute of Health, which is the agency in the US that funds most medical research in the United States, co-owns the patent on the Moderna vaccine. They benefit financially the NIAID, Dr. Fauci’s division of the NIH, and four members of the NIAID personally get royalties and will get royalties for the rest of their lives and their children will get royalties for the rest of their lives from the profits from these vaccines. So if you begin to follow the money, if you begin to recognize that at least in the United States until 1997, pharmaceutical companies were not permitted to do direct to consumer advertising on television. You wouldn’t turn on the TV and see and ask your doctor about Viagra commercial, or ask your doctor about Prozac commercial because it wasn’t permitted under federal law.
That changed a couple of decades ago and now at least in my country, every fourth or fifth commercial is a pharmaceutical commercial. So the news agencies that are responsible for asking tough questions supposedly, and opening things up for public debate have been very silent also on the vaccine mandates because some of their largest advertising contracts are with pharma companies that stand to profit. Even the medical journals, 80% of the revenue that sustains peer reviewed medical journals comes from pharmaceutical advertising in those medical journals. So until some of these of financial conflicts of interest are disentangled, whether it’s peer reviewed medical journals, whether it’s the mass media, whether it’s research institutions that rely heavily on pharmaceutical funding or NIH funding that benefits from pharmaceutical revenues, until these things are disentangled, there are going to be very strong perverse incentives built into the system to act, not in the interest of the health and safety and wellbeing of the population, but in the commercial interests of corporations that stand and individuals that stand to profit from a certain type of public health response.
Dr. Richard Schabas:
Coming back to Kulvinder’s point. There were lots of great points there which I certainly agree with. But why has it been so different? Why have we sort of thrown our principles under the bus in dealing with COVID? We used to talk 30 years about AIDS exceptionalism, now it’s kind of COVID exceptionalism. Everything is different and there are at least a couple of reasons. There’s the point that Aaron made about the professional threat people feel when they speak out and are critical, I know Kulvinder’s faced that as well. We just very recently, chilling experience in Ontario, where the minister of health sort of publicly threatened doctors. She sent a letter to the College of Physicians and she made this kind of blanket threat to any doctor who criticizes the safety or effectiveness of vaccines, whatever that means, that she’s threatening them or pressuring the college to threaten them with the loss of their medical license which is a very, very serious threat to wave at doctors so it has a very chilling, chilling effect on debate.
But I think in a broader sense people have, from the very beginning, bought into the idea that this is some sort of an event, it’s an extraordinary event. Make no mistake about it, COVID has been a very serious public health event, but the idea that it’s unprecedented, that it surpasses all other threats that we have faced in modern history and this was based, I think again, on the models that told us not only that 40 million people were going to die, but they were going to die within a few months. It was all going to happen by mid-summer of 2020 and of course it didn’t because the models were wrong as they have been consistently wrong about so many other diseases and wildly wrong, but it didn’t matter.
We bought into the notion that this was the supreme test of us, supreme test of our will, of our resolve and that the reason 40 million people didn’t die by the way wasn’t because the models were wrong, it’s because of all the things that we did, even when we didn’t do them so that’s the kind of paradigm people bought into. I can’t help but think back, well first of all, to all the failed pandemics that I’ve seen from swine flu in 1976 through SARS through bird flu but I’m just old enough to remember 1957 and the Asian flu, which by the way, was a much more terrible event in terms of mortality and morbidity than what we’ve faced with COVID and the conventional wisdom is, between two to four million people died in 1957 from the H2N2 pandemic.
The world had one third the population then that it has now, and half the proportion of people over age 65 so a similar event now, would’ve affected in the neighborhood of six times as many people, killed as six times as many people, 12 to 24 million. So COVID has been a terrible event, but it doesn’t begin to compare to what the world faced up to in 1957 and by the way, it came back with new “waves”, we hear all about waves, came back every year for the next nine years and killed millions more people but we’ve forgotten about that. We live in an age where we’ve forgotten about that. We’ve bought into this idea that this was this tsunami of death, this microbiological apocalypse and because of that, all the rules don’t apply. All this stuff about ethics, about do no harm, about determinants of health, about evidence based medicine, none of it counts anymore because of the magnitude of the threat. We’ve lost all sense of perspective in dealing with this because we’ve anchored ourselves in an event that didn’t happen and was never going to happen, at least not anywhere near the magnitude that we were led to believe.
Dr. Julie Ponesse:
I have a couple of thoughts to build on that. One is, we do seem to have a purity culture and I think our propensity for canceling is part of that but I think an interesting question is, how does the idea that a virus is endemic fit in a purity culture, right? I think part of our problem here, maybe part of our focus on the vaccinate to COVID zero sort of strategy is that in order to feel comfortable, in order to feel safe, we need to eradicate all threats. And the idea that a virus would be with us, that it would never go away, even if we are told or we have good evidence to believe that its presence would not pose to us a significant threat but the idea that it’s there, that we haven’t conquered it, that we haven’t had control over it, that we haven’t purified ourselves of it, I think in this era is a difficult concept for us to come to terms with and that might be why we’re inclined to hold on to this idea of vaccinating our way out of it because the other options don’t feel so purifying, just maintaining a healthy lifestyle.
And my goodness, the problem with getting natural immunity in a purity culture is you have to get yourself tainted. You have to have come into contact with the virus and that, I think, doesn’t sit well in our modern culture. Another thing that’s become very clear throughout the course of the pandemic in that I think almost every comment we’ve made today has talked about is the punitive nature of the way that we communicate with the public and the way that professionals are handled, the example of Christine Elliot basically using the CPSO as an enforcement mechanism to deal with physicians who stray outside of the main line.
And if you think in ethics, we talk a lot about motivation and how do you best motivate people and we know that if you want to achieve a certain outcome, a positive motivation is much more effective than a negative motivation or a punitive one. And we also know that intrinsic motivation is not only more effective than extra intrinsic motivation so getting people to enjoy their work deeply rather than finding meaning in their work, rather than just giving them financial incentives, it’s much more effective. And by the way, it also makes us happier and contributes overall to our quality of life so the fact that we’re seeing the main strategy communicated by the government and our public health officials is a punitive one. It’s no wonder we are so, I think, hard on each other and exhausted and terrified and demoralized, and there are other ways of achieving that end.
There are other ways of keeping people healthy, but I think we need to deal with some of the root causes of these problems. And one of which I mentioned which is this purity issue and the other is this issue of disciplining in order to achieve our desired ends. And it’s very interesting because the ethical literature on corporal punishment for example or any form of punishment for departing from the laws, shows that merely punishing someone is not a great deterrent. That other forms of correcting behavior are more successful and they’re less harmful on the individual and they contribute to society in better ways. And so all of that is to say that our whole strategy, it’s not unsurprising that it’s causing a lot of problems.
Dr. Kulvinder Kaur Gill:
It’s interesting Dr. Ponesse, how you mentioned a lot policies are very punitive in nature and it seems that they’re not grounded in ethics or in evidence, but in a goal to achieve that punitive nature. And as Dr. Kasher mentioned, the prime minister of Israel was demonizing his citizens, similarly in Canada, we’ve seen our prime minister demonize Canadians and throughout history, we have learned from the past that denying people of their humanity can have devastating horrific outcomes. And we are seeing that with our political leaders who are trying to other a group of people who are trying to make them as though they’re an untouchable class, as though they’re somehow subhuman and it’s with definitions that never existed before. We used to, in the medical context, use the words immune and non-immune and now we’re using these new words, vaccinated versus unvaccinated.
So we’ve created new arbitrary terms, which then the definitions are ascribed by governments, which may not necessarily be based in evidence or in ethics. And then demonization happens from those arbitrary definitions and aside from what history teaches us, Dr. Martin Kulldorff had recently said that he feels that we’ve reached the end of the age of enlightenment, that through the silencing of debates, silencing of ideas, exchange of ideas, expression of dissent, we are not allowing for the progression of science. We’re not allowing for the questioning of policies and that’s what ensures that we have policies that are grounded not only in ethics, but in evidence and that’s how we actually progress as civil societies. And so when we’re seeing the silencing of debate, when we’re seeing the silencing of dissent and punitive outcomes through colleges or medical boards, or through universities to not question the government, what is the ultimate outcome of that? And this demonization, this othering of groups of people based on arbitrary edicts from the government, where does this lead us? And how do we change that?
Dr. Aaron Kheriaty:
I’d like to follow up on that because I think that question is also a good segue to the sort of second half of your earlier question about the origins of these medical doctrines. So we can look at the Nuremberg code, which came from the Nuremberg trials, which came as a reaction to Nazi medicine and the atrocities that were committed on patients during the Holocaust and of course, when you mention the Nazi analogy, people tend to sort of freak out so let me clarify. This is a historical cautionary tale and by discussing the origins of the Nuremberg code, I’m not trying to compare our current leaders to Nazis. I’m just trying to show how really a society can begin to veer off course and then go very badly wrong if that’s taken to its logical conclusion. And it’s instructive to notice that German medicine went off track before the Nazis came into power, starting in the 1920s, there was a very influential book published by a psychiatrist and a lawyer on the destruction of, in German, Lebensunwerten Lebens, Hoche and Binding’s book, which advocated for the euthanasia of cognitively and mentally and physically disabled individuals.
A program that was later advanced of course and taken up by the Nazis, but was embraced by German medicine during the late Biomark Republic, even prior to Hitler’s coming to power. So German medicine was primed by the eugenics movement, eugenics ideas to go in the wrong direction. 45% of physicians joined the Nazi party, even though Nazi party membership was not a requirement to be a physician, it was voluntary. It might help with advancement and academic medicine under that regime but we can compare it to teachers in Germany for example, only about 10% of teachers joined the Nazi party. So what happened to German medicine, which by of the way in the 1920s and 1930s was the most advanced and prestigious in the world. German medical institutions were at the forefront.
They’d be equivalent to kind of the great medical institutions in the western world today, but what happened was a very subtle shift. It’s been hinted at earlier, and that I’m starting to see percolate through the public commentary and that’s the idea that the physicians primary loyalty should not be to the individual sick patient in front of them, which is the traditional Hippocratic ethic. The patient is vulnerable. The patient needs to trust that the physician will put all of their knowledge and skills only in the service of helping them, of healing them, of minimizing harm, will involve them in decision making, that’s the principle of autonomy, and will treat them fairly, that’s the principle of justice. That traditional Hippocratic ethic, which is enshrined in the Nuremberg code and these other historical documents that we’ve mentioned is now being set aside in favor of a kind of social ethic, no the doctors should be responsible for the health of the population as a whole.
Well, this was tried in Germany in the 1920s and 1930s. There was this notion that the social organism could be healthy or sick so the doctor’s responsibility was to the Volk, to the people as a whole and this analogy of the social organism being healthy or sick was taken to the extreme, such that what happens if in an organism you have cancerous cells, well, what do we do with a tumor? We carve it out and we get rid of it for the sake of the health of the whole. So when this analogy was applied to society, it led to justification of euthanasia regime, which began under the Nazi T4 Euthanasia Program prior to the Holocaust. The first individuals that were gassed in Germany were not in concentration camps. The first gas chambers were in psychiatric hospitals and the first individuals who were gassed were not Jews or other ethnic minorities, they were mentally disabled psychiatric patients and these were signed off by psychiatric physicians in Germany. That paved the way to the atrocities that everyone is familiar with.
So this is obviously an extreme example of what can go wrong when that traditional Hippocratic ethic is abandoned. The reaction to that was this doctrine of informed consent, the Nuremberg code, which people should read is less than a page long. I mean it’s a dozen sentences or so, you can read it very quickly in a minute or two. And it articulates in very clear terms, the central principle of informed consent. That’s what the Nuremberg code is in essence and that was seen, I think, correctly by the world as the necessary bulwark against the atrocities that happened in German medicine during the Holocaust and actually prior to the Holocaust that paved the way for many of the attitudes that expanded that eugenic mindset, was expanded to include not just physically and mentally disabled patients, but other “undesirables.”
So when physicians place their knowledge and skills, not at the service of the patient, but at the service of a broader social program or broader social ends, what happens when the people directing that social program, when the regime directing that social program is misdirected and misguided. An extreme example of this happened in Germany but we shouldn’t think that it’s impossible that it could happen elsewhere. The German people were not backwards barbarians in the 1920s and 1930s, German medicine was not backwards and barbaric. It was considered among the most prestigious medical institutions in the world.
Dr. Richard Schabas:
Yeah, I’m an encourageable optimist so to answer your question, I think we will come out of this. I think we’ll bear some scars, but I think we will come out of this. Perhaps another analogy, one that maybe doesn’t have quite as much emotional baggage, would be the McCarthy period in the United States, in the late forties and up to the mid fifties, where basically again, because of fear, just like with the Nazis. The Nazis thrived off fear, fear of all the bad things that had happened to Germany, fear of foreigners, fears of Jews. McCarthyism thrived on fear, fear of the Soviet union, fear of communism, fear of nuclear war and it meant that a large swath of people with progressive ideas were penalized in a variety of ways. They lost their jobs.
They were forced to take loyalty oaths, all kinds of bad things happened but it ended and it ended because it overreached itself. I guess, Nazism overreached itself too but in a much more catastrophic way for the world, but McCarthyism overreached itself too when McCarthy started accusing the army of harboring all… So it collapsed on itself. And I’m optimistic that, I mean, one of the great tragedies of COVID has been the lack of debate, the lack of collegiality, the lack of open-mindedness and it’s been very distressing but I think that the COVID, they kind of painted themselves in to a corner. They have invested so much in things like masks and vaccines and lockdowns, which are manifestly failing.
And we’re beginning to see at least some recognitions in places like the United Kingdom and maybe in Florida and in Netherlands and places where they’re throwing in the towel, it’s overreached. And I think that once it overreaches and once we recognize that’s happened, that we’ll go through this kind of catharsis, like we did with McCarthyism and we will emerge from that with some scars. But I still think we are going to return to our liberal ethos which among other things, particularly in medicine has always embraced the idea of debate and descent and it’s a tragedy we’ve lost that, but I do think we’ll come back to it.
Dr. Asa Kasher:
I’d like to point out a different perspective, the pessimistic perspective, not optimistic at all. I mean, let’s think about the role played by medical ethics in the life of a physician or a nurse. What is it for them? And you can draw analogies with other professions. What is it in the life of a lawyer? What is it in the life of a combatant officer? Now there are two possibilities. One possibility is that, okay, they have a profession that is defined by some knowledge and some proficiency, and they can perform activities on grounds of that knowledge, with the help of that proficiency and that’s it. Now from somewhere emerged an idea of norms that should be imposed on them so you have knowledge and you have proficiency that defines your profession. And then there is some extra level of norms, medical ethics, ethics of lawyers, military ethics, but that perception, that understanding of medical ethics leaves major ingredients of medical ethics outside the picture of the profession.
Now, autonomy is not part of knowledge or proficiency. Autonomy is sort of imposed on the professional activity of the physician so as long as medical ethics does not become part of the definition of the profession, but being viewed as something that has been added by lawyers, by governments, by Supreme court, by whoever on the profession then we are going to see under so called emergency conditions, a throwing away the whole idea of that extra ingredient that enter our life. I can bring an example, a brief example from the history of the ethics of lawyers. Perhaps all of the crooks in the Watergate affairs were lawyers, right? How is it possible that lawyers were being educated in law schools and being educated in law schools of higher reputation of elite universities.
How come they were such a gang of criminals? Now when you look at it, you see the history of teaching ethics to students in law school. Before Watergate, there was no class that the topic of which was ethics of lawyers. Professors were assumed to address it somehow, whatever the topic of the class is. Now after Watergate, they started teaching classes in ethics of lawyers. So before Watergate, it was not part of the profession. It was just something that hovers above their heads. After it, it became part of their identity. Now present day physicians and nurses don’t take it as part of their identity that they treat individuals who are autonomous, who should be respected, that human dignity is at the core of the core of the interaction because, because you care for them, then you have to treat the medical problems.
You have to make decisions on scientific grounds. You have to respect their views, respect their background culture, respect effects of what you do. So I think there is a crisis, what we have discovered under COVID is that there is very weak role played by medical ethics in the education of physicians. They teach them a sack of ideas and not a professional identity. It doesn’t go deep into their identity of what is being a member of this profession, but just covers some areas with principles that, under emergency, which everything is shaking then we can get rid of this extra component of the activity.
Dr. Julie Ponesse:
I feel like Dr. Schabas has been very optimistic and Dr. Kasher is pessimistic. So I’ll try to strike a balance. One of the great casualties of this pandemic situation has been the loss of the fiduciary relationship between not just physicians, but whoever your primary healthcare provider is and the patient. And that fiduciary comes from the Latin word for trust.
Seeking medical care, needing medical care, you’re in a position of incredible vulnerability and it makes a lot sense that we’ve spent conservatively maybe 40 years and less conservatively maybe 2000 years building up the idea and the literature to support it. That trust should be at the center of this relationship between healthcare providers and people when they become patients. And one of the things that makes that trust so important is because we’re so vulnerable in that situation.
So I think the pessimistic part is that we’ve lost that. We’ve seen healthcare become conspicuous. This vaccination issue is not between individuals and their doctors behind the closed door in a doctor’s office anymore. There are mobile clinics and vaccination clinics at the Air Canada Center. The Air Canada Center is our big sports venue in Toronto. And on the scoreboard that, they list how many people. And it’s ticking away how many people are getting vaccinated.
It’s become this very public conspicuous event. And we have these stickers to say I’m vaccinated and labels to go on your Facebook page, all of these things. And I think that there’s hope for healthcare in general for human health in general, if we can rescue it from the public arena and put it back in that intimate, protective space where patients can attend to their vulnerability and feel like they can be vulnerable. We’re kind of back to that punitive issue again, but not be punished for their choices. That it just isn’t going to get us anywhere.
Dr. Kulvinder Kaur Gill:
The last key issue I wanted for us to discuss was about vaccine passports. And I think Dr. Kasher will bring an interesting perspective to this because Israel is the furthest along in terms of boosters, I believe your vaccine passport to be fully vaccinated now involves four doses and is soon to possibly involve the fifth. Here in Canada, we are onto the third and they’re thinking about expanding the definition for fully vaccinated to be the third dose. And on, and on we go.
And this is being implicated in terms of participation in society and to go on about daily life. And we are seeing the constant moving of goal posts. And where does this all lead us? And how has something medical now become something political and now leading to surveillance of everyday society?
Dr. Aaron Kheriaty:
I think vaccine passports are a dangerous harbinger and there, they should be for us a kind of Canary in the coal mine signaling what is to come if we don’t put a stake in the ground and say, “No, this is not the kind of society that we want to live in.” So access to basic public spaces, basic human goods and services, transportation, food, travel, public gatherings, and the right to assembly should not be contingent on accepting a forced medical procedure.
Regardless of whether that procedure is well advised or ill advised. I think we can set aside that question about the role of vaccines in this pandemic and so forth. And still recognize that two years ago, most people around the world would’ve found it completely unacceptable to have to show a QR code, to get on a train, get on a plane, eat in a restaurant, or gather in a public space. That level of surveillance and control would seem to people, I think rightly so to be an unwarranted intrusion on their privacy and to give unwarranted endangers, powers into the hands of people that control that infrastructure of opening and closing those gates.
And I think part of the push for mass vaccination has come from political and economic interests that want to see that infrastructure of vaccine passports in place. That want people getting used to a so-called new normal of having to demonstrate their good citizen credentials in order to access the basic means of being part of our society. And this melding of public health, militarization of public health that has occurred. Melding of public health with police powers with state powers, leading to language like pandemic countermeasures.
I mean, this term countermeasures is not a medical term that I’ve ever heard in any medical context. It’s a military term. It’s a term derived from Spycraft really. So that this melding of public health with police power and with digital technologies that allow for this very granular level of tracking and control and data gathering of not only where you’re gathering, where you’re going, what you’re doing, what you’re spending money on, but who you’re gathering with as well, who you’re associating with as well. Living in this fish bowl 24/7, that lacks the basic means of privacy.
And that has the potential to open and close doors that would constrain people’s freedoms very severely. I think to my mind, this is the most concerning development of the entire pandemic, what I’ve called the emergence of the biosecurity surveillance regime. And by regime, I don’t necessarily mean that it’s all government controlled either. I mean, private institutions have been more than happy to serve as necessary gatekeepers and implement these kinds of structures and be party to this new infrastructure.
So it’s not just top down government or corporate control, but there’s many different institutions at all levels of society that seem all too willing to participate in the name of safety or in the name of getting a handle in the pandemic. But once that infrastructure’s in place, I think it’s going to be very hard to wind it back. There’s just too many other potential uses for it by people that have political or financial interests.
Dr. Asa Kasher:
Okay. I have a passport because I’ve been vaccinated four times, but I seldom am being asked to show it. Actually in my iPhone, I can show it on my iPhone. So if I’m entering a restaurant, if the waiter would ask me to show that I have a passport, I can do it easily. But most of the time they don’t ask for it because Israel, I don’t know if you know Israel or not, but Israel is a very informal society. Regulations are okay. There are regulations and then there is the implementation and manifestation and those other things concerning those regulations.
So passports, the passports are less dangerous than they seem because there is a problem here of making decisions on some top level and then expecting millions of people to behave accordingly. Doesn’t work that way. So it’s not so dangerous, but the whole conception is mistaken. The whole conception of those green passports as they are called here. So there are two misconceptions on which the whole arrangement rests.
One of them is the conception of danger. Which means that a person has not been vaccinated is dangerous and we should exclude him or her from every public arena. I spoke about it already, that’s a completely wrong conception and shouldn’t be used. But it is being constantly used. And it’s at the grounds of that passport perception.
Secondly, there is something even worse, a misconception concerning of how does a democracy impose limitations on the liberties of its citizens. Just by waving hands by some cabinet that hears or does not hear experts or non experts and making common sensical and political and economic decisions. This is not a proper way for running a democracy. You want to forbid my entrance into a certain area, which is not a private proper of my neighbors, but a public area.
Then there should be a whole procedure showing that this is effective. This is optimal. There is a balance of benefits and risk, which justifies it. It’s a very complicated and important procedure that we should use in order to impose some limitation, some restriction on the liberties, but we have never done it. And you should do it openly. The public, the citizens should know why has his activities, his movements been restricted by the government. And we are very far from having the right conceptions, directing the activities of those who make the general public decisions concerning our movement in this example, but also other aspects of our life within the context of the pandemic.
Dr. Richard Schabas:
So I practiced public health for 35 years or almost 35 years. And I think if you’d asked me this question two years ago, I would’ve spoken about the need for public health to have the authority in some circumstances to intervene in ways that compromise people’s liberty, the need for coercive action by public health. I would’ve qualified that by saying it has to be very clearly justified. It has to be based on evidence. It has to be the minimal intervention possible. But the person with active TB, infectious TB, who won’t take their medications, I would’ve argued it’s reasonable to put them in hospital for three weeks to give them their medications so that they don’t infect others.
I would’ve made that argument. I would’ve never anticipated what’s happened in the last two years. I would’ve thought there are plenty of checks and balances. The first being the reasonableness of public health doctors, but also the legal constraints, the standard of evidence that are required, the role of the courts to be able to intervene, to prevent abuses. But of course, what’s happened in the last two years has been just an abuse of those authorities and the checks and balances have not worked. And public health doctors have not behaved in the reasonable and moderate ways that our basic principles should have led them to. And the courts have not intervened. The politicians have not intervened. The media has not been critical.
And it’s made me think again, that if authorities like that are potentially subject to the degree of abuse that we’ve seen in the last two years, maybe they’re not worth it. Maybe in fact, again, I’m not sure where I stand on this. Maybe we need some tougher constraints or maybe we have to think it through again and say, “Yeah, it’s too bad if somebody gets infected with TB when we could stop it. It’s a tragedy, but it’s less of a tragedy than every kid in Ontario missing a year of school, much less of a tragedy.” And so if that’s the balance I have to think long and hard about where I stand on this issue. It would’ve been very much clearer to me two years ago that it is now. It’s been a profoundly disillusioning experience.
Dr. Kulvinder Kaur Gill:
To shift to a positive note. We do know that at that the vaccine as we’ve discussed, doesn’t stop transmission and it doesn’t actually stop infection. And the presence of natural immunity has been denied by governments. So the logic behind the implementation, even in there was an ethical framework, isn’t there either. And as you have mentioned, Dr. Schabas, there are some jurisdictions in the world that have announced that they’re actually abandoning the vaccine passport such as England and Ireland and Denmark.
And hopefully as more and more public questions arise, and as we see the protests as we are now starting to see globally, governments will start to abandon that ship. This has been a very insightful discussion. And I’m thankful for all of you for making the time to allow for this discussion. Unfortunately, we’ve lost Dr. Ponesse, but I was hoping that you would be able to leave all of us with some closing remarks in terms of either your thoughts of the response or where you see this heading, or just anything that you would like to share.
Dr. Aaron Kheriaty:
So I’d like to encourage citizens who may feel disempowered to start taking back your civic responsibilities there. For two years, we were told that the highest form of civic participation was social distancing. That is to say non civic participation is a very strange standard of civic life. And we were told to listen to experts whose policies I think have failed. So I would remind citizens that you are in possession of logic. You are in possession of common sense and rationality, which all human beings share. And no one has a monopoly on those things. So don’t outsource, you may not be a virologist or an epidemiologist or a physician or whatever, or an ethicist, but don’t outsource your rationality and your common sense.
If you’re being told something by the authorities, that’s directly contradicts something that they said last week, or that has its own set of internal contradictions. If things are not adding up start asking questions, start feeling empowered to critique and make judgements on policies that just don’t add up or that don’t make sense. I think it’s very important for people to feel that they can once again participate in the democratic process. People of working class person might say, “Well, what can I do? I’m not like the people on this seminar that have a voice, have a microphone, have a professional credibility because of their degrees or their credentials or whatever.”
But truckers are changing the world right now. And they’re probably having a bigger impact than people like me. So take heart. I mean, collective action is very, very powerful and it’s very, very inspiring. So I think it’s time for people to regain those social bonds of solidarity to come together. And sometimes coming together to demonstrate publicly that they’ve drawn a line in the sand and they’re not going to allow their civil or human rights to continue to be violated in this way. I think ultimately, that’s what’s going to put a stop to misguided pandemic policies.
Dr. Kulvinder Kaur Gill:
Thank you, Dr. Kheriaty.
Dr. Asa Kasher:
I think we should have a new perception, new conception of how a democratic state should run. I mean, the structure and the functioning. Let me give you the Israeli example first, and then you can generalize it. We have just two levels in the whole story of handling the situation. We have decision makers and we have enforcement forces. And enforcement could be the police, could be our counterpart of the FBI or other agencies. Now this doesn’t work. This cannot work and since it is under the pressure to show successful achievements, then it breaks medical ethics, breaks understanding of constitutional democracy. And it gets worse and worse.
I think that if you look at the British, the British police has a slogan, which consists of four Es. Engage, explain, encourage, enforce. Which is beautiful. I don’t know whether the whole British situation manifests this conception, but my idea is, first I engage with the public. Then I try to explain the situation, the steps that have been made. Then I encourage them to do this or that. If worse come to worse, and all this has not helped a lot then I start to enforce the policies.
But we must have different levels. Between the decision makers up there in the ministries of health, or the president of the US, or the ministers of Canada, or the prime minister of Israel, between them and the public, there must be additional levels. One of which, most important one of which is the medical professions. The situation shouldn’t be like that. I mean there are decision maker and then the public and the medical professions are somewhere helpful or can be ignored. They should constitute an intermediate level.
The whole interaction concerning the pandemic should be with my physician, not with the policeman or police woman at the corner of the street or the minister, the prime minister. Should be with my physician. And that physician should not have an interaction with the decision makers, but with some organization, a professional organization with the right attitude towards ethics of the profession. And so the whole system should be run differently, both in its structure and its functioning. And this is why I’m pessimistic because getting those changes implemented with those politicians and those lazy physicians, I’m not optimistic at all.
Dr. Richard Schabas:
So in clinical medicine, we’re trained that when you’re faced with a crisis and you don’t know what to do, you go back to your basics. You go back to your ABCs, airway, breathing, cardiovascular, you don’t panic. You do what your experience, your training, the evidence says you should do. When we’re faced with a crisis like COVID, and COVID has been a crisis. When we’re faced with a crisis like this, it’s not the time to abandon your basic principles, the fundamentals of your practice, the fundamentals of your science. It’s the time to embrace those things. It’s the time to rely on those things.
We haven’t done that. I think we need to reboot, rethink, go back to those basics, go back to the things that have gotten us to 2022, where we have this outstanding level of health in the world. Where we have done so well with so many diseases, so many health problems. And tragically, that’s not what we’ve done. To me, that’s the takeaway message.
Dr. Kulvinder Kaur Gill:
Thank you, Dr. Schabas. Well, I just wanted to thank all of you once again for making the time for this very enlightening and impactful discussion. And I’m hopeful that your words will resonate not only with the profession, but with the public as well. Thank you.
Dr. Richard Schabas:
Thank you for doing this, Kulvinder. It’s been great. Thank you. Great to meet all of you.
Dr. Aaron Kheriaty:
Pleasure. Terrific conversation. Thank you all.
Dr. Asa Kasher: