What happens when something is “ethically impossible”? It goes underground. You may remember the scandal last year when it was revealed that U.S. government researchers knowingly infected people with STDs. Not here, but in Guatemala, where 1,300 prisoners, soldiers, and psychiatric patients were infected with syphilis, gonorrhea and chancroid, between 1946 and 1948. What is worse, only about half of these subjects received some form of treatment, even though penicillin and other effective medicines were available. Some of them died during the research.
The President’s Commission for the Study of Bioethical Issues the research further,[1] to ascertain whether these experiments were unethical at the time. That could depend on the research standards in the late 1940s, and what the researchers knew.
First, what was the context for the research? The goal of the study was to find ways to inoculate against the spread of STDs, which was a medical priority for the military after World War II. Previous experiments conducted at Indiana’s Terre Haute prison had failed. With funding from the U.S. government, and the consent of local officials, U.S. researchers moved their STD experiments to Guatemala.
Next, there were several key differences between previous studies and the Guatemala research. In the Terre Haute experiment, the researchers obtained informed consent, fully explaining the nature and risks of the experiments to the volunteers, all of whom were at least 21 years old. In contrast, the Guatemala experiments did not require informed consent or age limits. Some of these human subjects were children as young as 10 years old. In many cases participants were intentionally deceived about their exposure to STDs. This evidence led the Commission to conclude that even by the standards of its time, this research was unethical.[2]
Finally, the researchers knew there were violating ethical standards. An article written by the New York Times science editor declared that it would be “ethically impossible” to intentionally expose humans to syphilis.[3] In response to the article, the lead researchers decided to increase secrecy and limit the release of information for fear of public opposition.[4] This indicates that they knew these experiments were wrong, even though they were pursuing a good goal.
This August, the President’s Commission issued their report titled “Ethically Impossible.” They concluded that the Guatemala study failed to uphold the most basic ethical principles. Researchers did not treat people fairly and with respect; they incurred unnecessary harm; and they used other people as a means to reach a medical goal. These are all violations of human dignity. As Amy Gutmann, the Commission’s Chair said, “Research with human subjects is a sacred trust.”[5]
We can be glad that this unethical research has been exposed and apologized for. Let’s hope it is never repeated. All research that exploits human beings should be off limits as “ethically impossible.”
[1] Presidential Commission for the Study of Bioethical Issues, ‘Ethically Impossible’: STD Research in Guatemala from 1946 to 1948, (Washington D.C.: Presidential Commission for the Study of Bioethical Issues, 2011) http://www.bioethics.gov/cms/sites/default/files/Ethically-Impossible_PCSBI.pdf.
[2] ‘Ethically Impossible,’ 6, 7, 41, 92-93.
[3] Waldemar Kaempffert, “Notes on Science: Syphilis Prevention.” New York Times, April 27, 1947.
[4] ‘Ethically Impossible,’ 10, 75, 76, 100.
[5] Presidential Commission for the Study of Bioethical Issues, “President’s Commission Concludes Investigation into 1940s STD Experiments in Guatemala,” news release, August 29, 2011. http://bioethics.gov/cms/node/280.