The Tuskegee Syphilis Study refers to a medical research, whichhappened in Tuskegee, Alabama from 1932 to 1972 (Ogungbure 78). Theobjective of the study was to evaluate the development of syphilis.The subjects involved poor African American males, and theresearchers’ intention was to determine the consequences of nottreating syphilis. The researchers located subjects in their secondphase of syphilis, and periodically conducted investigations on themen to find out how their bodies were affected by the illness.
The study subjects were informed that they would be getting medicaltreatment due to having “bad blood”. Instead, they were subjectedto agonizing spinal taps and were never treated for syphilis. Thedoctors conducting the study allowed some subjects to die, despitethe fact that penicillin had already been discovered as an effectivetreatment. There exist well-known ethical principles aimed atprotecting human subjects in biomedical studies from exploitativeresearchers. Nevertheless, the principles were dishonored in theTuskegee Study.
The following discussion is an ethical analysis of the TuskegeeSyphilis Study. The research paper argues that it was morally wrongbecause many ethical considerations, which are mandatory whenconducting scientific research using human subjects, were unobserved.
Human beings face many health challenges, and medical studies havebeen effective in inventing treatments that either control or curethe illnesses. In most cases, people are used as subjects in thescientific research conducted by medical practitioners, which raisesethical concerns. The objective of moral values is to guarantee thatany study using human subjects is conducted with consideration to therights of participants. Research ethics also acts as a dogmaticframework that ensures subjects are not exploited (Ogungbure 76).However, in the case of the African American men used in the TuskegeeSyphilis Study, many ethical principles were violated.
The research entailed extensive deception. By the time the experimentwas stopped, “28 of the men had died directly of syphilis, 100 diedof related complications, 40 of their wives had been infected, and 19of their children had been born with congenital syphilis” (Gorski1). Hence, the question arises as to how the subjects agreed toparticipate in such a study. According to Gorski (1), in order toconvince people to take part in the experiment, one of the medicalpractitioners performing the analysis convinced subjects by lyingthat the research was aimed at providing treatment.
Initially, subjects were given syphilis remedies, though in verysmall quantities such that it was impossible for them to becomecured. The remedies were merely a public show to gain the confidenceof the people. In the end, all the treatment was substituted withaspirin doses. To make sure the research participants continued toshow up for the experiment, they were issued with letters hyped as“last chance for special free treatment” (Gorski 1). Theobjective of the doctors was to ensure that the African Americanmales showed up for another excruciating and harmful spinal tab. Inaddition, they were not informed that autopsies would be carried outonce they had passed away.
One of the doctor’s involved in the Tuskegee Syphilis Study statedthat “if the colored population becomes aware that accepting freehospital care means a post-mortem, every darky will leave MaconCounty” (Gorski 1). This is a clear acknowledgement that theexperiments were conducted without the consent of the AfricanAmerican males, since they were deceived about the real reasonsbehind their participation. It was expected that the research wouldbe conducted in a period of six months, but it lasted for years untila venereal illness investigator, Peter Buxtun, revealed the realityconcerning its unethical nature (Ogungbure 78-79).
The study was morally wrong because it violated several ethicalprinciples, which guide any study involving human subjects. Theseprinciples are the respect for persons, beneficence andnonmaleficence, justice and informed consent (Kim 6).
Respect for Persons
The principle includes two ethical assurances, “first, thatindividuals should be treated as autonomous agents, and second, thatpersons with diminished autonomy are entitled to protection”(Gostin 62). An autonomous individual refers to someone able topremeditate about personal objectives and act based on the directionof the premeditation. Respect for autonomy implies that the opinionsas well as choices made by autonomous individuals are respected.Failure to respect such a person’s decision results in denial foran autonomous agent to make an informed consent (Gostin 62).
Nevertheless, not all individuals are able to make decisions on theirown. This could be due to one’s age, mental disability, sickness orin situations where freedom is limited. In the case of research usinghuman subjects, “respect for persons demands that subjects enterinto the research voluntarily and with adequate information”(Gostin 62). This means that no one should be compelled to take partin a research without voluntary consent. Since under this principle,people are self-governing, they have the right to refuse toparticipate in an experiment, and researchers must respect thisautonomy.
It is obvious that in the Tuskegee Syphilis Study, the researchparticipant’s autonomy was not respected. The subjects comprised ofindividuals who were of legal age, and had the ability to contemplateon the issue and decide whether to become participants or not. Thesubjects had the right to be informed about the real motive behindthe study. Instead, the subjects were not informed that they hadsyphilis, but were deceived that they had “bad blood”, whichcoerced them to want to become participants. By failing to tell thetruth, the doctors disrespected their subjects.
Beneficence and Nonmaleficence
The ethical principle refers to the incorporation of “thephilosophy of ‘do no harm’ while maximizing risks to the researchsubjects is applied through risk/benefit assessments” (Kim 6).Beneficence implies to acting in manners that portray kindness. Onthe other hand, nonmaleficence means to avoid actions, whichexacerbate a problem or result in negative outcomes. The principlesevaluate the advantages and disadvantages, or possible harm, whichmay arise when performing a study.
Under beneficence and nonmaleficence, researchers are expected to actin manners that are in consideration of the best interest ofparticipants and the population at large. In addition, researchshould not be conducted when it is known that it will cause more harmthan good to the study participants. Hence, the ethical principlestates that researchers should not deliberately injure oneindividual, in spite of the benefits to a larger population (Gostin62-63).
In the Tuskegee Syphilis Study, the ethical principles of beneficenceand nonmaleficence were knowingly violated. The doctors performingthe study acted against beneficence by causing harm to theirsubjects. Despite being aware that the African American men hadsyphilis, they failed to give them adequate and available treatment.Instead, they subjected them to painful tests under the disguise thatthey were freely treating them. As a result, the participantscontinued to participate in the study thinking they were receivingtreatment, yet their health continued to deteriorate.
On the other hand, the research caused more harm than good, henceviolating the principle of nonmaleficence. Although the researcherswanted to study how syphilis progresses in the human body, by failingto treat the sick, they failed to benefits their subjects andpopulation at large. This is because, people died, the illness wastransmitted to spouses and children were born with congenitalsyphilis.
Justice is defined as “ensuring reasonable, non-exploitative, andwell-considered procedures are administered fairly and equally andapplied to the selection of research subjects” (Kim 6). Aninjustice happens when the benefit entitled to an individual isdeprived with no good rationale. When conducting research using humansubjects, research on the ethical principle of justice indicates thatpeople should not be manipulated to become subjects. In addition,individuals should not be selected due to their ease of availability,or compromised situation they may be experiencing (Gostin 63).
Gostin (63) explains that the Tuskegee Study manipulated its researchsubjects into taking part in the study. Also, the subjects wereselected due to the fact that they were easily available. Theresearchers took advantage of the fact that the African American mencame from poor backgrounds. Hence, it might have been impossible forthem to access care from hospitals where they would be required topay. Considering that the researchers advertised their treatment asfree, this may have lured participants to volunteer.
At the time of the study, syphilis was a major health concern inAmerica. Thus, it was easy for researchers to get subjects from thegeneral population. However, there was a clear violation of justicebecause the study targeted only African American males. This posesmany ethical questions. One is the possibility that the researchersassumed that only black men had the disease. By failing to includesubjects from different races, one may conclude that the researchtargeted African Americans, hence was racially biased, which is aform of injustice towards the population.
Informed consent is a very important ethical consideration,especially when research is carried out using human subjects. Byinformed consent, it means that an individual is able to decide onwhat actions to take in regard to their wellbeing (Ogungbure 83).Hence, effective communication must take place between the researcherand the subject, prior to a subject agreeing to become part of anexperiment. The communication involves discussing the reason for thestudy, risks, gains, improbabilities, impact of the decision, andconducting an assessment to guarantee that an individual comprehendsthe issues at hand.
The right to have an informed consent was violated in the Tuskegeestudy. The subjects never understood the real nature of the research.They were fooled into believing that they would be getting treatmentat no cost. Although there was communication between the researchersand subjects prior to study commencing, the discussion was marred byfalse information. This leads to the conclusion that the Tuskegeesubjects lacked an informed consent. Instead their consent was soughtvia deception.
The subjects were not informed about all issues relating to theresearch. Thus, many participants were unaware of what they weregetting involved in. For instance, they thought that they were beingtreated for “bad blood”. This means that many did not know theyhad syphilis, resulting in avoidable deaths, sickness andtransmission of syphilis. It was necessary for the researchers toinform the African American men taking part in their study about thecorrect illness they were suffering from. By concealing suchinformation, the doctors violated the subject’s right to know aboutthe study.
Also, considering that most of the participants were from poorbackgrounds, it is possible that they were not well educated. As aresult, they easily believed what the researchers told them to betrue, since the investigators were experts in the medical field. Thisleads to the conclusion that the doctors took advantage of thesubjects’ lack of knowledge to get them to participate in theTuskegee study. As such, the researchers acted unethically by takingadvantage of the fact that the target participants were incapable offully comprehending the nature of the study.
The Tuskegee Syphilis Study was without a doubt unethical. All theethical principles that should have been considered were ignored.Thus, it was morally wrong for such an investigation to be conducted,and yet last for years. The researchers failed to respect the freedomof their subjects, regarding to whether they were willing to becomeparticipants, by failing to inform them about the real motive of thestudy. The principle of beneficence and nonmaleficence was violatedby conducting a study that was aimed at causing harm to human beings.Justice and informed consent were also disregarded because theAfrican American male subjects did not know the real nature of thestudy.
Gorski, David. Human SubjectsProtections and Research Ethics: Where the Rubber hits the Road forScience-Based Medicine. Medicine,27 Apr. 2009. Web. 6 Aug. 2016.https://www.sciencebasedmedicine.org/human-subjects-protections-and-research-ethics-why-randomized-clinical-trials-cant-always-be-done/
Gostin, Lawrence O. PublicHealth Law and Ethics: A Reader.Berkeley, California:University of California Press, 2010. Print.
Kim, Won O. Institutional Review Board and Ethical Issues in ClinicalResearch. Journal of Anesthesiologists, 62.1(2012): 3-12.
Ogungbure, Adebayo A. The TuskegeeSyphilis Study: Some Ethical Reflections. Thought and Practice: AJournal of the Philosophical Association,3.2(2011): 75-92.