An Analysis of the Tuskegee Syphilis Study

The Tuskegee syphilis experiment was an infamous study experiment that was carried out on black Americans to find out how untreated syphilis progressed naturally. The study was carried out by the U.S public health service between 1932 and 1972. The researchers carried out the experiment while lying to the public and the research subjects that they were receiving free medical aid from the United States government (Russet, 2009). During the study, ethical principles were not upheld due to the fact that those who had contracted the disease were not put under any treatment. This led to the tabling of the Belmont report in 1979 which was a summary of the guidelines that should be used when carrying out human subjects based research as well as the ethical standards that should guide the same (CliffNotes, 2015). 

Ethical Principles

Respect for Persons

In the application of this principle, there are two convictions that are ethical. These include the fact that individuals have to be treated as agents who have autonomy and the second conviction is that those whose autonomy is diminished should be highly protected. An individual who is autonomous is able to deliberate and come up with personal decisions and goals and is therefore able to act based on those decisions (Ogungbure, 2011). The individual is shown lack of respect when their judgments are repudiated, when they are denied the freedom to perform depending on their own decisions and when information that would help them come up with a reasonable judgment is withheld with no good reason. 

Moreover in researches that involve human subjects, the principle of respect of persons demands that the subjects entering the research should do so voluntarily and be given full information. However during this study, individuals were recruited under false information such as been told that they were patients of a medical intervention and were been treated for their bad blood. Since most of the participants came from a poor background they were also enticed by been given free medical care, food and death insurance. By targeting these people in an era of oppression, slavery and racism, the researchers were able to deceive them into consenting to the experiment which was anything but informed. The researchers thus implied that the blacks were more prone to venereal diseases since they were promiscuous and innately carnal in nature.

Beneficence

In addition to respecting people’s decisions and keeping them from being harmed, there should also be efforts towards their well-being (Ogungbure, 2011). Beneficence refers to charity or kindness that is beyond what one is required to do. It is an obligation. In this study, the principle of beneficence was violated firstly because the men involved in the experiment were never given adequate treatment for their disease, even after penicillin was discovered as a cure. The doctors ended up harming their subjects by not only refusing to provide them with the treatment but also lying and giving them controlled treatments so as to continue observing the full and long term evolution of the venereal disease. 

Justice

This is achieved by ensuring that individuals are not short changed and therefore get what they deserve. Another application of this principle is that people ought to be treated equally irrespective of their race or social-economic standing (Ogungbure, 2011). Justice is important in that whenever it is upheld, no individual feels inferior to others as they are all treated equally. The Tuskegee syphilis study was not justifiable because they opted to use underprivileged, rural black men for their experiments that are by no means confined to that population. Moreover, the participants were denied effective treatment so as to continue research of the project even after cure for the disease was discovered. By specifically using black men and women and justifying that the disease was more in relation to their race was a racial and biased conclusion that was in violation with the ethical principle of justice. 

The Nuremberg Code and the Belmont Report.

The Nuremberg Code came about as the Second World War ended due to the Nuremberg trials. These trials were against 23 German doctors who had sterilized over 3,500,000 citizens during the Second World War. As stated by (U.S Department of Health and Human Services, 2005), the trials were carried out by the United States and started in December of 1946. The elements are:

It is essential for the human subject to have voluntary consent. However, in this study patients were recruited without informed consent. They were deceived to think that they were getting free medical treatment and were not informed of their correct diagnosis.

The aim of the experiment should be for the benefit of the society and should not be done for any other reasons. The Tuskegee Syphilis Study was started with honorable intentions. This was to find out the occurrence of syphilis among rural blacks in the south and search for possible mass treatment (Apology to Survivors of the Tuskegee Syphilis Experiment, 2012). The researchers did conclude that mass treatment was possible and could be implemented but due to the Great Depression of 1929, the study was discontinued. However, the USPHS opted to continue with the studies and they chose Macon County since it had the highest percentage of syphilis. Despite the fact that the aims of the study was beneficial to the society the extreme measures used was even risker that their benefits.

The experiment should be based on the results of a previous animal based experimentation. This element was violated since the researchers never previously experimented on animals. Their experiment was purely based on humans.

The experiment should not have any form of suffering or injury. However this treatment was extremely harmful to the subjects since they used contemporary methods of treatment such as mercurial ointments and bismuth that were highly toxic. Moreover, even after finding the cure to syphilis, the doctors ended harming their patients by denying them treatment and many of them ended up dying slow and painful deaths of syphilis during the study. 

The experiment should not be conducted where it has been previously discovered that death or injury may occur. This study was initially meant to go for six to eight months but ended up being forty years. The study was terminated in 1972 and by then only seventy four of the initial four hundred men were alive (Human Experimentation: Tuskegee Syphilis Experiment, 2011). This clearly indicated that the researchers did not value the lives of their patients and even after noticing the harm it brought about they still continued with their experiments. 

The risk of the experiment should not exceed the benefits to be derived from the experiment. The Tuskegee syphilis study ended up being risker that the benefits, however, the researchers still ignored their patients’ well-being so as to fulfill their own ambitions.

Measures and facilities should ensure that there is no resultant disability, injury or death. This element was violated since the experiment lasted forty years and it involved major procedures such as spinal tap that had serious side effects one of them being paralysis in rare cases. Additionally, long term complications of syphilis if not treated correctly included death and the patients were denied proper treatment.

It should be carried out only by qualified personnel. Most of the African American health workers, even nurse Rivers had no understanding of the experiments and they believed that the benefits of the study in the society outweighed the risks. However, Nurse Rivers morality became questionable after being appointed the chief person and was the only employee who stayed with the organization for the full term

The human subject should be at liberty to bring the experiment to an end if he/she considers it harmful. Deceit was vital to the study of Tuskegee syphilis study and thus the patients never figured out that the experiments were disadvantageous to their health. Moreover, promises of free medical treatments and meals were appealing since most of the participants were from a poor background. 

The scientist conducting the experiment should be in a position to terminate it at any stage if need arises. This was not the case in this study, to a point they did want their patients to die so as they can continue with the research by doing an autopsy on their body. Thus, the researchers did more harm than good and were in violation of most of the ethic codes in healthcare.

The Belmont Report and why it was written.

The Belmont Report was written as a result of the ethical violations of the Tuskegee Syphilis Study. It was written by the National Commission for the Protection of Human Services and Behavioral Research. The report lays down the ethical principles to be used in experiments that utilize human subjects. 

Universal Declaration of Human Rights

This was a declaration that was embraced by the U. N. G. A. in Paris in the year 1948. The declaration was drafted and adopted after the Second World War due to the widespread violation of human rights (U.S Department of Health and Human Services, 2014). Even though it is not legally binding, it has been applied in international economic transfers, national constitutions, and international treaties. The bill turned into an international law in 1976 and was to be adhered to by all nations under then United Nations. The rights of the human subjects in the Tuskegee Study were violated when those who had contracted syphilis were denied treatment using penicillin. Their rights were also violated when the experiment was not halted once it was made clear that there would be no funding from the government. 

Tuskegee Study Nurse

The nurse in the Tuskegee syphilis study was an African American lady called Eunice Rivers. She was mainly motivated by the money the government was paying her for the role she played in convincing black men to participate in the study. Nurse Rivers convinced the men that the study was for the good of the society and that they would be treated if they were found to have contracted the disease. When she realized that the study was no longer being funded by the government, she withheld this information from the human subjects. She also did not inform those who had the disease that they had tested positive and the implications of the illness. She instead told them that they had ‘bad blood’ (Miss Evers Boys, 2015). Her actions were therefore not justified or ethical, she should have applied the principle of beneficence when working for the study putting into consideration that her fellow African Americans were being oppressed by the study. As a nurse, she should also have ensured that those who had then disease were treated promptly to prevent further spread of the same and to improve the quality of life of the individuals. 

Researchers’ Behavior in Tuskegee Study compared to Present Day Expectations

The researchers’ behaviors in the Tuskegee Syphilis study were devoid of high ethical standards. This is evidenced by the fact that they carried on with the study without adequate funding. They also did not treat the subjects of the experiments who were found to have syphilis knowing very well that the illness had debilitating lifelong effects. Present day researchers use animal subjects before they can proceed on to human subjects. This is so as to determine whether the experiment will have any negative effects on human subjects. This was however not done in the Tuskegee experiment. The actions of present day researchers are influenced by the Nuremberg code, the Universal declaration of Human Rights and the Belmont effect by the fact that there would be no repeat of a research study whereby the rights off the subjects are not observed. Moreover, by learning the repercussion of the Tuskegee syphilis study, health care officials can now follow policies, principles and ethic codes that help govern their day to day work. In cases where they need to study sexually transmitted diseases in different ethnicities they will need to do their studies in accordance to the Nuremberg code, Belmont code and Human Rights. 

Conclusion

It is very important to ensure that human rights are upheld at all time and that ethical standards are maintained when carrying out research studies. Ethical principles such as beneficence, justice and respect should be adhered to so as to ensure that the subjects are in good condition and well protected. Elements of the Nuremberg code should also be followed to then letter as they govern the ethical starting and progression of research studies. Although the government later apologized for the way the study had been carried out, the damage had already been done and it is therefore very important to never have a repeat of the same.

References

Russert, B. (2009). A Study in Nature: The Tuskegee Experiments and the New South Plantation. Journal of Medical Humanities, 30(1): 155-171

Ogungbure, A.A. (2011). The Tuskegee Syphilis Study: Some Ethical Reflections . Retrieved from file:///C:/Users/America/Downloads/74876-169310-1-PB%20(2).pdf

U.S Department of Health and Human Services. (2005). The Nuremberg Code. Retrieved from 

www.hhs.gov/ohrp/archive/nurcode.html

Apology to survivors of the Tuskegee Syphilis Experiment. http://www.youtube.com/watch?v=F8Kr-0ZE1XY

Human Experimentation: Tuskegee Syphilis Experiment. http://www.youtube.com/watch?v=iMeVcT-X2AA

U.S Department of Health and Human Services. (2014). Office for Human Research Protections (OHRP) . Retrieved from

http://www.hhs.gov/ohrp/policy/consentckls.html

Miss Evers boys. http://www.youtube.com/watch?v=nHP1p9bRQ3Q

CliffNotes. (2015). What principles of the Belmont Report were violated in the Tuskegee Syphilis Study? Retrieved from

http://www.cliffsnotes.com/cliffsnotes/subjects/history/what-principles-of-the-belmont-report-were-violated-in-the-tuskegee-syphilis-study