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    Tuskegee Syphilis Experiment

    Post by Joey JoJo Shabadoo on Fri May 10, 2013 3:19 am

    Joshua Soedjono
    Professor Douglas Green
    PHIL 210: Ethical Systems
    6 May 2013
    Debate on Human Guinea Pigs: Ethical or Unethical?

    As of this moment, there are many ethical debates on many key issues. The issue of using people as guinea pigs in research experiments without their consent is a particular case. The use of people as guinea pigs in research experiments without their consent can be seen as immoral.

    The Public Health Service and the Tuskegee Institute held a study to find out "how syphilis affected blacks as opposed to whites—the theory being that whites experienced more neurological complications from syphilis whereas blacks were more susceptible to cardiovascular damage" ("The Tuskegee Syphilis Experiment"). To get volunteers for this research, the researchers told subjects "they were being treated for 'bad blood', a local term used to describe several ailments, including syphilis, anemia, and fatigue" ("The Tuskegee Timeline"). They accepted because they given free medical care and they became unwilling guinea pigs ("The Tuskegee Syphilis Experiment").

    To get more people to experiment on, they used a misleading letter filled with "promotional hype" ("The Tuskegee Syphilis Experiment"). It claimed that the experiment was the final opportunity for a special treatment. ("The Tuskegee Syphilis Experiment"). During the experiment, the scientists collected the data from the autopsies of dead patients, so basically the scientists let them suffer from the many debilitating symptoms of syphilis: "tumors, heart disease, paralysis, blindness, insanity, and death" ("The Tuskegee Syphilis Experiment"). They withheld this information as they wanted more uninformed patients to experiment on.

    The scientists blocked off the patients from participating in "several nationwide campaigns to eradicate venereal disease" ("The Tuskegee Syphilis Experiment"). When penicillin was discovered in the 1940s, the scientists blocked off access to penicillin for the patients ("The Tuskegee Syphilis Experiment"). They still persisted with the experiments even though the Henderson Act, "a public health law requiring testing and treatment for venereal disease" passed in 1943 and the Declaration of Helsinki, a declaration passed by the World Health Organization "which specified that 'informed consent' was needed for experiments involving human beings" ("The Tuskegee Syphilis Experiment").

    John Rawls would have found the Experiments held by the Tuskegee Institution to be unjust. In this case of this incident, the social inequality lies within the poor syphilis-infected patients. According to Rawls, "social and economic inequalities...are just only if they result in compensating benefits, and in particular for the least advantaged members" (Rawls 384). In other words, Rawls believes that inequalities within the system are fair only if everyone gets benefits from the inequality. The patients got "free medical exams, free meals, and burial insurance" as benefits for participating in the study ("The Tuskegee Timeline"). However, the Tuskegee Institute refused to personally treat their infections, the patients never got the "compensating benefit" they deserved. Also, Rawls would have considered the withholding of information a form of unjustified inequality because all patients have the equal right to know whether participating in the experiment itself is a sound choice or not.

    Immanuel Kant would have argued that the horrible treatment of the syphilis patients by the scientists is immoral by his Deontological Ethical System. The categorical imperative, in Kant's mind, is this: "Act only on that maxim through which you can at the same time will that it should become a universal law" (Kant 510). Basically, the categorical imperative has to be followed in all circumstances, even if it causes the person some detriment. In this case, the categorical imperative broken by the researchers is the categorical imperative of not lying because scientists told the infected that they will be treated by them, but in reality, they never got the treatment they needed.

    The categorical imperative chosen in this case is the categorical imperative of always helping out others in need. This categorical imperative comes from the assumption that humans are good people at heart. They broke this categorical imperative, as the scientists denied them the chance to participate in the campaigns to cure sexually-transmitted infections and they also blocked off the penicillin. Eunice Rivers, "a central figure in the experiment for most of its forty years", claimed that they were following orders ("The Tuskegee Syphilis Experiment"). On the other hand, Nurse Rivers still broke this particular categorical imperative as they compromised their morals just so they can get recognized by the Public Health Service. In fact, a Tuskegee doctor claimed that the experiment gave the Tuskegee Institute prestige in the eyes of the Public Health Service ("The Tuskegee Syphilis Experiment").

    Another categorical imperative the scientists have broken is the Hippocratic Oath. Even though the Hippocratic Oath came before the birth of Kant himself, it still follows the traditional terminology of the Categorical Imperative because it tells "a new physician to swear ... that he will uphold a number of professional ethical standards" ("Greek Medicine - The Hippocratic Oath"). One of the tenets of the Hippocratic Oath is "I will do no harm or injustice to [my patients]" ("Greek Medicine - The Hippocratic Oath"). The scientists experimenting on the syphilis patients broke this because they caused the patients harm during the experiments. One of the scientists even mentioned that they were not interested in the welfare of the patients who participated in the Tuskegee Syphilis Experiment until they died ("The Tuskegee Syphilis Experiment"). Lying is considered a form of breaking the Hippocratic Oath because it is considered an act of corruption, and the Hippocratic Oath says that the student should "[avoid] any voluntary act of impropriety or corruption" ("Greek Medicine - The Hippocratic Oath").

    On the other hand, modern versions of the Hippocratic Oath itself are at odds with the Greek version of the oath itself. In a medical school survey made in 1993, "14 percent of modern oaths prohibit euthanasia, 11 percent hold covenant with a deity, 8 percent foreswear abortion, and a mere 3 percent forbid sexual contact with patients—all maxims held sacred in the classical version" (Tyson 1). In fact, more doctors are beginning to agree that the Hippocratic Oath is becoming outdated and have asked many questions based on the exceptions to the Hippocratic Oath.

    For instance, there is the physician-assisted suicide. The Hippocratic Oath does not mention what to do in this situation. The patient wants to end their lives and thus their suffering, but the doctor cannot end their suffering because assisting the patient in killing is technically considered a form of harm. Also, the oath mentioned that the doctor "will not give a lethal drug to anyone if [they are] asked, nor will they advise such a plan", so a physician-assisted suicide in that manner can be considered a breach of the Hippocratic Oath ("Greek Medicine - The Hippocratic Oath").

    There's also the fact that pagan worship is a major part of the Greek Hippocratic Oath. At the beginning of the oath, the doctor has to swear "by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as [their] witnesses, that, according to [their] ability and judgment, [they] will keep this Oath and this contract" ("Greek Medicine - The Hippocratic Oath"). There are people who don't believe in the Greek Gods for various reasons such as having a different religion or being an atheist. If a doctor of a different religion tries to take the Greek Hippocratic Oath, they would break the Categorical Imperative of their religion, as the Greek Hippocratic Oath involves taking an oath with Gods that exist outside the scope of their religion. If an Atheist tried to accept the Hippocratic Oath, it would be contradictory to their principles because the Oath is telling them to accept the existence of a God in a way.

    The Greek Hippocratic Oath also mentions that the doctor "will not give a woman a pessary to cause an abortion" ("Greek Medicine - The Hippocratic Oath"). In essence, the doctor cannot participate in the abortion of a pregnant woman. Today, modern medical technology has improved massively over ancient Greek medicine and thus there are more viable methods of abortion. As a result, there is a major debate between two sides: pro-life and pro-choice. Pro-life argues that the baby has a right to live and pro-choice argues that the abortion is just because the mother has the right to do whatever she likes with her body.

    A growing amount of governments and health-care organizations are trying to get patients' information, which basically means it is becoming increasingly difficult for doctors to keep information private (Tyson 1). Many people would claim this invasion of privacy is justified because the information used for one patient could be applied to other patients and could cure them. Basically, this invasion of privacy is another values dissonance between modern times and the ancient Greek era.

    There's also the fact that modern scientists have discovered incurable, fatal diseases such as AIDS and Ebola. The Greek Hippocratic Oath specifically does not mention what do in this situation, as these particular diseases were not in the medical dictionaries back, then. The ethical conundrum is based on two choices: letting the patient die because there is no cure for the disease or keeping the patient alive but forcing them to suffer from the painful symptoms of the diseases themselves.

    John Stuart Mill would have been against the experimentation if he saw the results of the experiments. According to Mill, supporters of Utilitarianism only "regard the dry and hard consideration of the consequences of actions, not taking into their moral estimate the qualities from which those actions emanate" (Mill 334). To Mill, "the best proof of a good character is good actions" (Mill 334). Basically, Mill would ethically judge a person by the consequences of their actions. The scientists claimed that the study was "for the greater good of science", yet Mill would have argued that the deaths and the vague results produced by the study would not justify the inefficient methods used by the scientists at all ("The Tuskegee Syphilis Experiment"). Mill also would have mentioned that "the men had in fact received some medication for syphilis in the beginning of the study, however inadequate, it thereby corrupted the outcome of the [study itself]" ("The Tuskegee Syphilis Experiment").

    Another reason why Mill would criticize the experiment is Nurse Rivers. Mills said, "as between his own happiness and that of others, utilitarianism requires him to be as strictly impartial as a disinterested and benevolent spectator" (Mill 333). Basically, whenever a person makes an Utilitarian ethical judgment, they have to be neutral. In addition, Mill adds that the Bible mentions that we should treat our neighbors in the same manner we treat ourselves (Mill 333). Basically, Mill would have criticized Nurse Rivers because she made a biased judgment in order to get some self-pleasure. Mill would have criticized Nurse Rivers because she did not treat the patients in a way she would like to be treated.

    An Ad Hoc Advisory Panel was formed in July 1972 and they said it was unethical because "the knowledge gained was sparse when compared with the risks the study posed for its subjects" ("The Tuskegee Timeline"). A month later, the Tuskegee Study ended. One year later, the study participants and their families filed lawsuits against the Public Health Service and the Tuskegee Institute and won "lifetime medical benefits and burial services to all living participants" ("The Tuskegee Timeline").

    The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was created after the National Research Act was passed in 1974 ("Research Implications" ). The group created the principles for human research and tend to suggest ways to make sure the principles are followed completely. Also, "regulations were passed in 1974 that required researchers to get voluntary informed consent from all persons taking part in studies done or funded by the Department of Health, Education, and Welfare (DHEW)" ("Research Implications" 1). The studies by the DHEW had to be checked by the International Review Boards on whether they were ethical or not. Even today, the President's Council of Bioethics makes sure all American studies on humans are ethical.

    During the 1990s, President Bill Clinton held a speech in which he apologizes for the Tuskegee Experiment in front of the survivors of the Tuskegee Syphilis Experiment. Clinton states that America "failed to live to its ideals" during the Tuskegee Syphilis Experiment because the patients were betrayed by the Tuskegee Institute and the Public Health Service ("Presidential Apology" ). Clinton also adds that "remembering that past" is important because "[America] can build a better present and a better future" ("Presidential Apology"). Clinton also states, "medical people are supposed to help when we need care, but even once a cure was discovered, they were denied help, and they were lied to by their government" ("Presidential Apology").

    Clinton basically said the damages caused by the Tuskegee Syphilis Experiment cannot be fully repaired but he can say the apology is acknowledgment that the patients were mistreated. As a result of the Tuskegee Syphilis Experiments, Clinton announced several things: "a center for bioethics in research and health care" based in the Tuskegee Institute, which is dedicated to the victims of the experiments, an "increase [in Government] community involvement so that [America] may begin restoring lost trust" since there is very little participation in medical research among the African American community, more preparation in the fields of bioethics research, an increase in "postgraduate fellowships to train bioethicists especially among African Americans and other minority groups", and an extension to "the charter of the National Bioethics Advisory Commission to October of 1999 ("Presidential Apology").

    "Greek Medicine - The Hippocratic Oath." U.S National Library of Medicine. U.S. National Library of Medicine, 02 July 2012. Web. 11 Apr. 2013. <http://www.nlm.nih.gov/hmd/greek/greek_oath.html>.
    Kant, Immanuel. Groundwork of the Metaphysic of Morals. Trans. H. J. Paton Introduction to Philosophy: Classical and Contemporary Readings. Eds. John Perry, Michael Bratman, and John Martin Fischer. 5th ed. New York: Oxford, 2010. 504-20. Print.
    Mill, John Stuart. "Utilitarianism." Theories of Ethics: An Introduction to Moral Philosophy with a Selection of Classic Readings. Ed. Gordon Graham. New York: Routledge, 2011. 325-38. Print.
    Rawls, John. "A Theory Of Justice." 1971. Ethics: The Essential Writings. Ed. Gordon Marino. New York: Modern Library, 2010. 378-95. Print.
    "Presidential Apology." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 14 Sept. 2011. Web. 06 May 2013. <http://www.cdc.gov/tuskegee/clintonp.htm>.
    "Research Implications." CDC - NCHHSTP - Tuskegee Study - Research Implications. Centers for Disease Control and Prevention, 15 June 2011. Web. 09 Apr. 2013. <http://www.cdc.gov/tuskegee/after.htm>.
    "The Tuskegee Timeline." CDC - NCHHSTP - Tuskegee Study - The Tuskegee Timeline. Centers for Disease Control and Prevention, 15 June 2011. Web. 22 Mar. 2013. <http://www.cdc.gov/tuskegee/timeline.htm>.
    "The Tuskegee Syphilis Experiment." Infoplease. Infoplease, n.d. Web. 01 May 2013. <http://www.infoplease.com/ipa/A0762136.html>.
    Tyson, Peter. "The Hippocratic Oath Today." PBS. PBS, 27 Mar. 2001. Web. 02 May 2013. <http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today

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