From Nuremberg to Now
The world built the most powerful consent doctrine in human history. Then Fauci and his type quietly carved out the one place it matters most. We remain disciplined and at the ready by knowledge.
In 1947, a panel of American judges ended a trial with a single sentence that became the conscience of modern medicine: “The voluntary consent of the human subject is absolutely essential.” That is the first principle of the Nuremberg Code, and it was not written as an aspiration. It was written as a verdict — the distilled lesson of what physicians had done to human beings who were never permitted to say no.
Here is what almost no one is taught. That principle, born from the worst thing doctors have ever done, has never been repealed, weakened, or formally narrowed in the decades since. It runs straight through the Declaration of Helsinki, through the Belmont Report, and through the consent form a nurse will slide across a counter to you or your child this week. And yet, in one of the domains where it should be most ironclad, the system has engineered consent down to a signature on a document that the issuing agency itself says is not a consent document at all.
Look at the Vaccine Information Statement — the sheet handed out before an immunization. The CDC’s own guidance is explicit that a VIS is not an informed-consent form. The United States, for a procedure it performs hundreds of millions of times a year, has no standardized informed-consent process at all. The VIS exists because of the 1986 National Childhood Vaccine Injury Act — a law written at least as much to stabilize vaccine supply and manage injury litigation as to inform the person being injected. The most-administered medical intervention in the country runs on a disclosure instrument its own author declines to call consent. That is notQ an accident of paperwork. It is what happens when a principle survives in name while quietly dying in practice.
“No One Told Us”: The doctrine was always written in the aftermath
The uncomfortable thing about the history is its rhythm. We do not strengthen consent because we reason our way to it in calm rooms. We strengthen it after we are caught.
In 1914, Justice Benjamin Cardozo wrote that “every human being of adult years and sound mind has a right to determine what shall be done with his own body.” That sentence is now the bedrock of American medical consent — and it came out of a lawsuit over a surgery performed on a woman who had explicitly refused it. Nuremberg came after the camps. The Declaration of Helsinki, in 1964, came as researchers kept treating patients as means rather than ends. The Belmont Report, in 1979, came after the Tuskegee syphilis study — four decades in which the U.S. Public Health Service watched men die of a treatable disease, on purpose, without telling them — was finally exposed in the press in 1972.
Every pillar of the consent doctrine is a tombstone. Each one marks the place where the principle had already failed once before anyone bothered to write it down. Which raises the question this history forces but rarely asks aloud: if the doctrine only ever advances after a betrayal, what is being done to it right now, in the gaps where no one is looking?
If you read Popular Rationalism, you already know that official explanations rarely survive first contact with the primary sources. This is one of those cases where the gap between what we say we believe and what we actually practice is not hidden. It is sitting on the counter, printed on a half-page handout, in plain sight. Or handed out in a tablet with fine print too small to read and zero opportunity to question.
(This is not informed consent).
What it looks like from inside the review board
I have served on NIH Study Sections and IPAK-EDU runs an institutional review board. Part of what that means is unglamorous and specific: I read consent language for a living. I am one of the people whose job is to decide whether a study’s process genuinely informs the human being who will sign it, or merely extracts a signature from them. From that seat, the failure in routine medicine is not subtle.
A valid consent has knowable elements. The nature of the intervention. Its risks. Its benefits. The alternatives, including the alternative of doing nothing. And a decision made voluntarily, by someone competent to make it. Remove any one of those and what is left is not consent — it is documentation. The most common way the structure gets hollowed out is the quiet substitution of relative risk for absolute risk. “Cuts your risk in half” feels enormous. “Moves your risk from two in a thousand to one in a thousand” describes the identical effect and feels like almost nothing — and only the second framing actually lets a person decide. A great deal of what reaches patients as “information” is built, intentionally or not, to manufacture a yes rather than to produce understanding. Once you can see the difference, you cannot unsee it.
There is a fashionable rebuttal to all of this, and it is worth naming because it sounds reasonable. The argument runs that talk of patient “autonomy” has become a rhetorical trick; a way to push people away from expert advice and toward deciding alone. It gets the principle exactly backwards. Autonomy was never the right to decide alone. It is the right to decide informed — with expert input, against honest numbers, and free of coercion. But it is also the right to decide not misinformed by those same experts.
The doctrine does not pit you against a good physician. It obligates a good physician to you. The people who built it at Nuremberg were not anti-medicine. They were watching what medicine becomes when consent is treated as optional.
This is the through-line of a larger project I keep returning to here: the slow, bureaucratic erosion of the patient’s standing to know. It shows up in the VIS. It shows up in how trial results are summarized. It shows up in the difference between a recommendation, a requirement, and a mandate — three words the public is encouraged to hear as one. The pattern is now consistent enough across enough domains that the charitable explanation, the one where each instance is an isolated oversight, has become the harder hypothesis to defend.
What I decided to do about it
Describing a problem for long enough eventually obligates you to teach the antidote. So this summer, Bernadette Pajer and I are running, for the third year in a row, a 14-week live webinar through IPAK-EDU — Foundations of Informed Consent — that walks this entire arc, Nuremberg to now, one Wednesday at a time. Early individual rights, Nuremberg and Helsinki, the U.S. consent doctrine in both clinic and research, Right to Try, DNRs, vaccine choice, the special protections owed to pregnant women and children, privacy, and the constitutional questions that surface when emergency power collides with bodily autonomy.
It is a discussion, not a lecture. You read first, you arrive with questions, and two instructors: one coming from the science and ethics, one from decades of policy and legislative advocacy - work through them with you live. Every class is recorded, so you can return to any session and keep what you learn. The aim is not to make you distrust your doctor. It is to make you the kind of patient, parent, or practitioner that the consent doctrine was written to protect: someone who can read the form, and the history underneath it, the way the people who wrote the rules do.
Because the question the handout in your hand cannot answer is the one that actually matters: not what are you being asked to agree to, but whether you were ever given what you would need to agree to it at all. And the larger question underneath that one - the reason a principle this old keeps having to be rescued - is the part I am still working out, in public, here.
That part is not finished. It may be the most important thing I write this year.
So let’s discuss that, too. So that we remain engaged, armed with knowledge, and ready for every incursion.
Sign up at ipakedu.online for a membership to get 50% off this course ($110 → $55). It’s a workspace for all of us.
Wednesdays at 3pm. Live. Click the calendar. Stay informed.
Jack, you refer to Justice Benjamin Cardozo’s statement that “every human being of adult years and sound mind has a right to determine what shall be done with his own body.” You note that sentence is now the bedrock of American medical consent - and it came out of a lawsuit over a surgery performed on a woman who had explicitly refused it.
But what you fail to share is that the woman lost the case…because the wrong defendant was sued, she sued the hospital rather than the physician.
The physician, the nurse, the pharmacist - they all have a personal obligation to obtain voluntary informed consent before they proceed with a medical intervention, e.g. vaccination.
Yet when they vaccinate an individual who is under a vaccine mandate, being incentivised or coerced to submit to the intervention under threat of penalty, they cannot possibly obtain ethically valid voluntary informed consent under those conditions.
When we think of how widespread vaccine mandates have been for years - for children, for the military, for medical staff, and more recently for mass populations during ‘Covid’ - there is NO authentic voluntary informed consent for vaccination.
This is the massive scandal waiting to emerge, which has occurred because physicians and nurses and pharmacists have violated their own personal duty to obtain voluntary informed consent.
In the IPAK-EDU Foundations of Informed Consent webinar will you be turning the spotlight onto those who actually wield the needle, administer the intervention? And ask why have they abandoned their ethical duty?
Why do you think they use these pads to sign in the hospital and doctors offices, you never see the real information on there, your told to sign in a hurried situation like an emergency, surgery, office visit called your name. They know what they are doing, setting us up to be taken advantage of, not really knowing what you’re signing anymore.