The Tuskegee Syphilis Study

Question #5

In experiments on infants, it is obviously impossible to obtain the informed consent of the subject. This is also true in experiments on senile individuals. Does this mean that ethical considerations preclude using such subjects in any experiment?

Infants or senile individuals cannot be used because informed consent is one of the guidelines that has to be met when doing an experiment. Because they cannot give informed consent it is not ethical to use these individuals in an experiment.

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Question #4

The Belmont Report proposes three criteria for the evaluation of human subjects research, respect for persons, beneficence and justice, as described above in the introductory section. In what ways does the Tuskegee Study fail to conform to each of these criteria. (Be sure to clearly define each of these as you discuss it.) The Belmont Report distinguished three guidelines for proper etiquette in human experimentation: respect for persons, beneficence, and justice. Respect for persons indicates that each person, especially those with subordinate freedom, (including prisoners and inmates) has the proper protection they are entitled to. In the Tuskegee Syphilis Study, the subjects were not cared for in the best way possible. Even after penicillin presented a cure, the African Americans were refused treatment. The second guideline, beneficence, implied that no intentional harm should be put upon the patients, and the benefits of treatment should be maximized. The doctors of the study were aware of the fact that there was a possibility to better the health of the dependents. Even with this awareness, the medication was not provided to the victims of syphilis. It is also necessary that there be justice in the selection of those to be studied such as neglecting to choose those who with all probability would not benefit from treatment. The Tuskegee Study failed in this point because it was unfair to select those who lived below poverty level and most likely had never had medical treatment.

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Question #3

3. Eunice Rivers, the Afro-American nurse who played a vital role by befriending the Tuskegee Study participants and assuring their cooperation has justified her support for the project in terms of the fact that the attention that she and the other medical staff gave to the men was more than a non-enrolled, poor, Macon County resident was likely to receive. If you had been in her place, do you think you would have come to the same conclusion with regard to the ethical choices available to you?

I don’t think I would have been able to just stand by and watch men suffer; knowing that what was going on was wrong and cruel. She may have really needed the money so she didn’t speak out against it in fear of being fired but it was still morally wrong. I would not rationalize my actions in being acceptable no matter what type of environment these men lived in on a daily-basis.

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Questions - 1 &2

1. An explicit requirement of the Tuskegee study was that the subjects not receive available treatment for a debilitating disease, a clear violation of normal medical practice. Can you think of any situation in which not receiving available treatment would be an ethical procedure in an experiment?
I don't think it would ever be appropriate for subjects in an experiment to not receive treatment, unless the nature of the study was strictly observation, and the subjects consented to be observed. However, I don't think the subjects should have been kept from receiving treatment if they chose to do so. Restricting subjects from receiving treatment for a disease like syphilis was definitely unethical. For example, if scientists were conducting a study on the progression of AIDS, the subjects would consent to being observed. But, if an experimental treatment became available, the subjects shouldn't be stopped from receiving treatment.

2. The Tuskegee victims were not informed -- in fact they were deliberately misinformed -- about the nature of the study in which they were participants. A basic guideline for human subject research, specified in both the Nuremberg Code and the Belmont Report is the requirement of informed consent. What would have constituted informed consent in the case of the Tuskegee Study? If such informed consent had been obtained from the subjects, would this remove all questions about whether the Study was ethical?
It would have been difficult to obtain informed consent from the subjects in the study, partially because many of the subjects may have been illiterate. They may not have fully understood the study; or, the fact that they would possibly be receiving medical care in a region where proper healthcare was scarce may have coerced them into "consenting" to the study. Informed consent would have to have been recorded and saved. However, even if the subjects had been completely educated about the nature of the study, I'm not sure it would have been completely ethical. For example, restricting the subjects from receiving treatment after it was available was definitely unethical, even though the study was based on observing untreated syphilis.

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Summary of the Study

Experimentation on human subjects has always been risky, both medically and ethically, but necessary to the development of new drugs and cures. One of the first major modern situations arising from human experimentation led to the Nuremburg Trials and subsequent Nuremburg Code, created in 1947. The Nuremburg Trials were mainly concerned with the crimes of Nazi leaders; however, they also focused heavily on the experiments of Nazi doctors. The Nuremburg Code set international standards for medical research and human experimentation. The controversial Tuskegee Syphilis Study caught media attention in1972 and led Congress to release The Belmont Report. The report focused on three basic principles. One principle, respect for persons, stated that all people had the right to protection. The second principle, beneficence, stated that studies should maximize benefits while trying to decrease harm. The final principle, justice, stated that subjects for a study should not be chosen from certain groups or races. The Tuskegee Syphilis Study was based on studying the disease of syphilis, a disease that was easily recognizable, but did not have effective treatments available. Early treatments were haphazard and included dangerous poisons that were often deadly. The Public Health Service began a study of syphilis in the early 1930’s in Macon, Alabama. The two-year study showed that 36% of African-Americans in Macon were infected with syphilis, a percentage much higher than the national average.

In 1932, the PHS began a follow-up study in Macon. The goal of the new study was to observe the development of untreated syphilis in African-Americans. The study went on for forty years, with 616 African-American men. Four hundred and twelve were infected with syphilis, and 212 were used as controls. The subjects never knew the complete reason behind the study, and were not given treatment even after penicillin became an available treatment. The subjects that did recognize their condition were refused treatment if they tried to find it. Finally, in 1965, 33 years later, Dr. Irwin Schatz objected to the study for moral reasons. Schatz’s objection led to the creation of a review panel for the study. The panel found nothing wrong with the study and allowed it to continue. Soon after, Peter Buxtin, a specialist working on the study, resigned and contacted the Associated Press about the study. The AP released a story on the study July 25th, 1972, causing public outrage. The study was immediately ended.