We’re returning to Brian Lynch’s book, ‘Oxygenation is the Solution’ which we published in 2022. Now, with distance from the global epidemic event of COVID-19, let’s look at some of Brian’s arguments.
Legal and Ethical Arguments for HBOT in Treating COVID-19
The text presents a compelling case for the ethical and legal imperative of considering hyperbaric oxygenation (HBOT) in treating COVID-19, particularly in light of the significant risks associated with severe COVID-19 and the potential benefits of HBOT in mitigating those risks. The author constructs his arguments around the principles of informed consent, the application of the best available evidence, and the ethical considerations surrounding randomised controlled trials in the context of a pandemic.
Informed Consent and Balanced Disclosure:
Duty to Inform: Lynch argues that doctors, aware of HBOT’s established use in wound care and its potential to address hypoxic tissue injury (a key feature of severe COVID-19), had a clear ethical and legal duty to inform patients about this treatment option. This duty, he suggests, stems from the legal and ethical principles of informed consent, which mandate that patients receive balanced and comprehensive information about all reasonable treatment options, even those considered outside standard care. Failing to present HBOT as a potential treatment pathway, particularly given early anecdotal reports of its efficacy, potentially constitutes a violation of informed consent.
Patient Autonomy: The author emphasises that the ultimate decision-making power in healthcare rests with the patient. This principle of patient autonomy dictates that after receiving full and unbiased information about the risks and benefits of all viable treatment options, patients have the right to make choices that align with their values and preferences. In the context of COVID-19, the author contends that withholding information about HBOT, even if not yet universally accepted or supported by large-scale trials, undermines patient autonomy by limiting their ability to make informed decisions about their care.
Best Available Evidence in a Pandemic:
Ethical Guidelines vs. Rigid Adherence to RCTs: The author criticises the overreliance on randomised controlled trials (RCTs) as the sole basis for treatment decisions, particularly in the urgent and evolving landscape of a pandemic. He argues that the ethical guidelines for decision-making in a pandemic, as published by the Irish Department of Health, emphasise using the “best available evidence at the time”, which may include early clinical experiences, case reports, and a broader understanding of scientific principles related to oxygen and tissue healing. Waiting for large-scale RCTs, while important for long-term scientific validation, could have potentially resulted in preventable deaths during the pandemic, representing a failure to act on the best available evidence at the time.
The Opelousas Example: The case of the nurse in Opelousas, Louisiana, who recovered from severe COVID-19 after receiving HBOT, serves as a potent illustration of the potential consequences of prioritising RCTs over timely action based on available evidence. This case, mirroring the success reported in earlier studies from Wuhan, China, suggests that HBOT, even if not yet embraced as standard care, held promise as a treatment option and should have been offered to patients as part of informed consent.
Ethical Considerations of RCTs in a Pandemic:
The Nuremberg Code and Deprivation of Known Benefits: The author argues that the insistence on RCTs, particularly those involving a control group receiving a placebo or standard care, raises ethical concerns in the context of a pandemic where potentially life-saving information is already available. Citing the principles outlined in the Nuremberg Code, he highlights the ethical imperative to avoid exposing patients to known and potentially avoidable risks by withholding a treatment (HBOT) that demonstrated early signs of efficacy. This argument highlights the ethical responsibility to prioritise patient well-being and act on available knowledge, even when that knowledge falls short of the gold standard of RCTs, especially in a public health emergency where the potential benefits of timely intervention are substantial.
Conclusion:
The book underscores the urgent need for a shift in the approach to medical decision-making, particularly concerning interventions like HBOT, which, while not always fully embraced by conventional medical guidelines, hold significant promise based on existing scientific understanding and early clinical experiences. Lynch advocates for greater transparency, more balanced consideration of available evidence, and a stronger emphasis on patient-centred care, where informed consent, driven by comprehensive and unbiased information, is paramount. This shift, he argues, has the potential to improve patient outcomes, foster greater trust in doctor-patient relationships, and ensure that medical practices align with legal and ethical obligations, especially during public health crises like the COVID-19 pandemic.
*’Oxygenation is the Solution’ is available to buy from www.bookhubpublishing.com Amazon and selected bookstores.