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John Livingston

No Way!

No Way. Never in Idaho. Never in the USA.

I must have repeated those phrases 50 times over the past week as I have talked to physicians, PA’s., nurses and technicians from across the country and across our State. The occasion of their reaching out to me was my announcement that I was turning in my military DOD contractor’s card. I spent a total of 16 years on active duty and in the reserves in the Navy but have been teaching trauma courses to military surgeons and physicians since 1982.

I have taught under the auspices of the Defense Military Readiness Training Institute in San Antonio Texas, The National Center for Medical Preparedness at Wright Patterson Air Force Base in Dayton Ohio, the National Naval Medical Center—what it used to be called and still should be, and throughout Asia on several military bases. At the earliest possible time, my wife and I received the Covid -19 vaccine, so we are both eligible to travel with military orders. The issue of the Biden vaccine mandate for the military had no bearing on what the two of us have decided to do. But when I heard of the requirement that all military personnel and civilian military contractors had to take the vaccine, I had to rethink my own moral position and turn in my card. Choice yes. Coercion no.

Simply put I made the decision about vaccination that I thought was right for me, not because the government ordered me to do so. From the beginning I thought active-duty personnel were in the wrong. Prior to deployment commands have the authority to make their troops safe and in my military career I have taken over 16 different vaccinations prior to deployments and voluntarily for research purposes including voluntarily for anthrax and HIV—both experimental and given to me with appropriate informed consent being a requirement for being part of a test group. I extrapolated my feelings about “lawful orders” and vaccines to today’s Covid military mandates and have written about my feelings in this regard. It was pointed out to me by one of my fellow instructors that I wasn’t taking into account that the mandate was ordering military personnel and contractors to take an “experimental vaccine” and this was the bases for the declaration of an “unlawful order”. I am not a lawyer or JAG Officer, and I am sure the legalities of the situation have been finessed by clever lawyers, politicians, and “woke” military leadership to negate the “unlawful order” argument. But as a physician and surgeon I believe my original position as it pertains to military vaccine mandates was wrong—my wife gasped as she read this phrase while proof reading. Furthermore, it is the job of Sr. military leadership and the Department of Defense to ensure military preparedness.

Our military is growing weaker everyday under the hand of Mr. Biden and his crew—think of the botched Afghanistan retreat and listen to the discussions and leaks to major Newspapers this past week about our inability to defend Taiwan and confront China militarily in the Far East. But the news coming from Norfolk Virginia—Dam Neck that 80 Navy Seals were not going to take the vaccine and would be discharged in a less than honorable fashion was a terrible blow to our Navy active-duty personnel. The “tip of the spear” doing the job that those sitting in comfy offices on Capitol Hill or at The Pentagon don’t have the courage or talents or applied virtue to ever carry off. This situation needs to be fixed soon. Last week I would have sided with the bureaucrats and said the claim of an unlawful order was wrong and should not be honored. This week I feel differently.

The ambiguity of a mandate order for military family’s needs to be cleared up. Do the rules apply to kids going to either DOD schools or kids going to civilian schools or both? What about families living in Continental USA (CONUS) who have family members deployed overseas? Does the order apply to The National Guard and their families who are stationed or located in the communities where they serve?

I keep in my files—I still keep paper files, a classic New England Journal of Medicine article written by Evelyn Schuster on Nov. 17th, 1997, remembering the establishment of the Nuremberg Code and then later the Declaration of Helsinki.

Not being an attorney and having no expertise in medical jurisprudence I must rely solely on my common sense. During the “Covid crises” there has been to my eye a haphazard application of well-established clinical and experimental well-defined ethics. For example, it was recently opined by a former Idaho Attorney General that the doctor patient relationship extended beyond the traditional relationship as defined by Idaho Code, though he didn’t say where he found precedent for this new definition. In my opinion if it needs to be changed then the legislature should be the one that changes it, not a former AG opining in a newspaper. But let’s take on face value his argument. If the relationship is extended, then do the traditional medical ethical codes also apply to this NEW RELATIONSHIP? If so, do these new rules also apply to a government agency that inserts itself into the traditional relationship? Do CRISES STANDARD OF CARE ORDERS by the Executive Branch of Government place the same restrictions on this new relationship as they would on the “traditional relationship”? Do public health officials and people in the Idaho Department of Health and Welfare have the same obligations to patients as physicians, when they insert themselves into the clinical or research process?

I in fact believe that these Crises Standards of Care orders as defined by the Idaho Department of Health and Welfare web site are ambiguous and capricious. , I shall paraphrase what they have written as a justification for such orders: These guidelines are promulgated to help health care providers in extreme circumstances when resources and personnel are depleted. Are they “guidelines” or are they legal justification for not applying traditional “standards of medical practice” and continuing to honor the “traditional doctor patient relationship” and the ethical standards inherent in that relationship? Does this give institutions—hospitals, the opportunity to subjugate certain classes of patients—the elderly or infirmed into a less urgent categories of acuity and care? Is that one of the reasons why these organizations and doctor’s groups are advocating for such “Declarations of triage”? Recent articles have been written of practices so described being considered even at The Mayo Clinic!

Nuremberg tells us that any person with legal capacity should have free power of choice without any element of “force, fraud, deceit, duress, or any use of coercion”. Elements of knowledge are required for the patient to make their own decision. Informed consent, the core of the Nuremberg Code, has rightly been viewed as the protection of subjects’ human rights. The key contribution of Nuremberg was to merge Hippocratic ethics and the protection of human rights into a single code. The Nuremberg Code focuses on the human rights of research subjects, the Declaration of Helsinki focuses on the obligations of physician-investigators to research subjects, and the federal regulations emphasize the obligations of research institutions that receive federal funds.

It seems to me and I am not a lawyer, that it is a very slippery slope from a government commissar announcing a “Crises Standard of Care” order, to a hospital adopting “emergency clinical guidelines” And this can all be done—maybe it is already happening, without either the doctors of today or their patients even understanding the impact that such interventions have on their own individual circumstances.

When a government mandate is issued by a governor, or the head of the DHW, or a Health Board, that intrudes into the traditional relationship between doctor and patient, or when a patient is coerced into taking a treatment that has up to now been only deemed to be experimental, who is responsible for adverse outcomes? When a patient wishes to withdraw from such treatment but is not allowed to do so—-who is responsible? Who is medically and legally liable?

If a patient has a ventilator removed without a patient or a family’s consent or who has care withdrawn without such consent—-in the clinical setting there is the concept of the “withdrawal of heroic care” but always within the guidelines of well-established ethical and moral principles; who is medically, legally and morally accountable? The Emergency orders written in New York State by the Legislature and signed by Governor Cuomo expressly limited the liability of doctors, institutions, and government officials. Who then is accountable to patients?

We have put the cart before the horse. Emergency orders are being executed before any moral or ethical guidelines have been defined. In Idaho we have been told of instances where patients have not been allowed to discharge themselves from hospitals “against medical advice”. We have been told of patients being placed in different triage categories because of disease, age, or preexisting conditions. We have been told of patients having care withdrawn without the patient’s or the family’s consent or even being notified. I cannot believe that any of these “isolated” stories could be true. We have been told of government workers and teachers being mandated to take the vaccine. We have been told that our own neighbors. Friends and family have been mandated to take the vaccine and if they don’t, they will lose their jobs. We all know that these stories are true.

Our Governor could put an end to all of this by issuing an Executive order like the Governor of Florida Ron DeSantis did. No more mandates anywhere. Let heroes who have courageously served in war and on hospital wards, and in law enforcement keep their jobs. Just like my wife and I made our own decision about the vaccine the same opportunity and respect should be afforded to people deciding not to take the vaccine.

No Way. Never in Idaho. Never in the USA. MIGA (Make Idaho Great Again)

“Fight Like Hell” “Let’s Go Brandon”

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