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?
There are very few situations, but if the patient does not want the medicine or if the patient is allergic to the medicine, it would be ethical and right to refrain from giving them the treatment. If the woman is pregnant and the type of medicine she needs will kill her baby, her options are limited. The doctors have to do what she wants, but in doing that they are risking her life as well as her unborn child. In a research study, it is usually unethical to refrain from giving a patient medicine. If the researchers know that the disease won’t harm you or if they are positive that they have a new treatment that will work, it is more ethical. With Syphilis, the disease was deadly and very harmful. When they did not give them treatment they were killing the people. Although there are some ethical reasons why doctors wouldn’t want to give patients treatment, we feel that if a subject wants treatment they should get it.
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?
If the PHS would have told the subjects the true effect of the disease and how deadly it was, people would have made and informed decision and given informed consent. The PHS did not tell the subjects that they would not be given treatment for a disease that could kill them without it. They deceived the people. If the subjects would have been properly informed on the nature of the case, they probably wouldn’t have agreed to it. It would have made the study more ethical, but still wrong. If a subject wants treatment for a legitimate disease, they have the right to get it at all times, even if they gave informed consent. They have the right to decide if they live or not.
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?
No. If I was in her place, I wouldn’t have tried to befriend the participants and I wouldn’t have kept the true nature of the study away from them. The only reason they kept the study going after the discovery of Penicillin as the cure was to see the effects of syphilis on a long term scale. There was no reason, ethical or unethical, to submit the patients to this kind of injustice. She came to the wrong conclusion about ethical choices and many people were hurt because of it.
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.)
Respect for persons – they took many African Americans and took advantage of the fact that they were poorly educated and naïve and used that against them.
Beneficence – There was no benefit from the study for the PHS or for the patients. After the discovery of Penicillin as a cure, there was no reason to be studying the effects. The patients did not benefit, most of them got increasingly sick because they were refused treatment
Justice – They selected all African Americans, which is unjust. They also were treated unjustly when they were refused treatment, a thing that all Americans should be able to get.
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?
No. If the person is not in a state to give consent, the experiment cannot be performed. If it is in the best interest of the patient and the person assigned responsible for the person agrees. If the person is going to die without the treatment, that also gives more justice to the doctors.
Friday, March 27, 2009
Tuskegee Syphilis Study
Before World War II, clinical studies on human subjects were not monitored. Atrocities committed by Nazi doctors made it necessary for there to be guidelines, which led to the Nuremburg Code. The Nuremburg Code created guidelines for medical research involving humans. Later, in 1973 (after the Tuskegee Syphilis Study), the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research created the Belmont Report. The Belmont Report had three specific points: Respect for Persons, Benefits, and Justice.
The outbreak of Syphilis led to many controversies over human rights. Syphilis was a poorly understood disease that affected many people. Early treatments were very dangerous because they used poisons such as arsenic and mercury to treat the disease. It was necessary to learn more about the disease to see if the benefits of the treatments outweighed the risks. One study was conducted in Oslo, Norway. This study was compiled of all Caucasian. The next study was funded by the Julius Rosenwald Fund. It was a two year study in Macon, Alabama. 82% of the population was African American. The results showed African Americans were more likely to get syphilis. The Julius Rosenwald Fund refused to fund follow up research because it made the race look bad. In 1932, the PHS asked for a follow up study on the Macon research. They gained permission to use the Tuskegee Medical Institute, and recruited African Americans by telling them it was free blood tests. In all, the study had 616 African American men. 412 of them had syphilis, and 204 were used as control. Although the study seemed harmless to them, in reality it was the opposite. The subjects had not been told the true meaning of the study. Those who had syphilis were prevented from getting treatment, even when Penicillin became a known cure. Finally, Peter Buxtin and Dr. Irwin Shwatz questioned the injustice of the study. Peter Buxtin contacted the Associate Press, and reporter Jean Heller wrote an article on the study. People were outraged, and the study was closed in 1972 after 40 years of research.
The outbreak of Syphilis led to many controversies over human rights. Syphilis was a poorly understood disease that affected many people. Early treatments were very dangerous because they used poisons such as arsenic and mercury to treat the disease. It was necessary to learn more about the disease to see if the benefits of the treatments outweighed the risks. One study was conducted in Oslo, Norway. This study was compiled of all Caucasian. The next study was funded by the Julius Rosenwald Fund. It was a two year study in Macon, Alabama. 82% of the population was African American. The results showed African Americans were more likely to get syphilis. The Julius Rosenwald Fund refused to fund follow up research because it made the race look bad. In 1932, the PHS asked for a follow up study on the Macon research. They gained permission to use the Tuskegee Medical Institute, and recruited African Americans by telling them it was free blood tests. In all, the study had 616 African American men. 412 of them had syphilis, and 204 were used as control. Although the study seemed harmless to them, in reality it was the opposite. The subjects had not been told the true meaning of the study. Those who had syphilis were prevented from getting treatment, even when Penicillin became a known cure. Finally, Peter Buxtin and Dr. Irwin Shwatz questioned the injustice of the study. Peter Buxtin contacted the Associate Press, and reporter Jean Heller wrote an article on the study. People were outraged, and the study was closed in 1972 after 40 years of research.
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