Tuskegee Experiment and Modern Bioethics

Tuskegee Experiment essay introduction

Introduction: If one was ever told that a government agency deceived a group of socioeconomic, disadvantaged, sick people and put them in an experiment where they never gave consent nor were, they ever treated of their diseases when the cure was made available. ‘Evil’, ‘cruel’, ‘barbaric’, would be few of the words used to describe the scenario. But this exactly what happened in the 1930s to a group of African Americans in the Tuskegee experiment, which is the topic of this essay. Long before the bioethical concepts of: doing only what is right and beneficial to the patient/subject, treating the patient/subject as a human being and making sure the patient has full knowledge of what is being done to him/her, the described scenario was a common practice.

Conducted under the guise of a scientific experiment, the Tuskegee Syphilis Study was a racial unethical medical study which can be considered one of the most horrific medical scandals of the 21st century (Brandt, 1978). This begs the question, what was the Tuskegee experiment? How were black people convinced to take part in such an experiment – what elements prompted dedicated participation in such an experiment? Thesis statement: The following paragraphs will answer these questions, discuss the Tuskegee experiment in depth, the moral and logical reasons/excuses used to keep the government health department running such a horrendous experiment and the impact the Tuskegee Syphilis Study has had on modern day Bioethics shall also be discussed.

Discussion

Background: So, what really was the Tuskegee experiment? To fully understand this experiment it is imperative to understand that by the early twentieth century, the social and scientific prevalent thought was that African Americans were lesser humans, primitive, prone to diseases and crime. They were believed to always need structure and finding it difficult to assimilate to white society after slavery. Various “scientific studies” conducted showed that emancipation deteriorated the mental, physical and moral capabilities of the black population (Brandt, 21).

Also, viewed as sexual deviants, they were considered prone to venereal diseases due to their overdeveloped genital organs and insatiable sex drive. The socioeconomic condition of African Americans was totally discounted, and medical care was seen as wasteful on this population.

Caused by the spirochete bacterium, Syphilis is a sexually contracted disease, that leaves those infected with catastrophic results, ultimately resulting in death. At that time, there were no known safe/effective treatment or cure for syphilis, and it was an epidemic among rural Southerners of all ethnicities. Due to their low socioeconomic state, African Americans were most affected and often went untreated for most of their life’s. The United States Public Health Service (USPHS) saw this as a ready-made environment and decided to use these African Americans in Macon County in the Tuskegee experiment (Baker, Brawley & Marks, 1259).

Topic sentence: African American organizations, doctors and nurses took part in the study by recruiting the poorer African Americans and ensuring their continuous participation in the experiment. It should be noted that years before the Tuskegee study, a similar study looking at the effects of untreated syphilis had been carried out on whites in Oslo, Norway but was stopped in 1910 when arsenic therapy was discovered and considered as a viable means of syphilis treatment at that time.

Topic sentence: Funded by the Rosenwald Fund, the experiment was initially supposed to just study the effects of untreated syphilis in the black male, as it was believed that the effect of syphilis in blacks were different than in whites. The Rosenwald Fund was a foundation that funded many successful programs for African Americans such as education, healthcare. Unfortunately, the Rosenwald Fund was hit hard by the stock market crashing (which ultimately led to the Great Depression) hence, they had to withdraw their funding for the study.

Due to this lack of funding, the health department was unable to continue providing medication for the participants of the study and decided to continue using them for a scientific experiment without their realization. Evidence & citing: The participants were never informed of the fact that they were involved in an experiment and hence did not grant consent. Instead they were told they were being treated for “bad blood”, a term that was typically used to cover a wide range of diseases (Hagen, 33). The men were offered incentives of free check-ups, free treatment of any diseases other than syphilis, free meals and free burial autopsy postmortem.

Evidence & citing: Primarily intended to last between six to twelve months, the experiment went on for about four decades, twenty years after the discovery of penicillin as treatment for syphilis (Hagen, 33). Commentary: Throughout these years, the USPHS went to great lengths to make sure the subjects of the experiment did not receive treatment even after the discovery of penicillin. Evidence & citing: In 1934, a member of the experiment, Dr. Robert Vonderlehr, met with various local black doctors, telling them not to treat any of the experiment subjects (Brandt, 25). He also warned the Alabama Health Department not to treat any subjects who may come to them for treatment.

Vonderlehr provided a list of the subjects to these doctors and organizations, encouraging they be denied treatment. By 1941, the USPHS supplied the list of 256 names to the army draft board, requesting they be excluded from the draft. Commentary: Despite their best efforts, some subjects were able to secure treatment. This angered Vonderlehr, who wrote a report stating that those subjects receiving treatment and the physicians administering it were jeopardizing the experiment.

Evidence & citing: In the 1960s, the USPHS convened to evaluate the experiment, they rationalized continuing it, by arguing that the subjects were already at the point where no therapy could help them, and the subjects were getting the best care given their situation (Brandt, 26). This was a lie of course, as the subjects never received any medication which directly treats syphilis. In 1969, during a meeting at the Center for Disease Control, a group of physicians excluding one, agreed to keep the experiment going stating they would never have this opportunity again.

Evidence & citing: It wasn’t until 1972 when the study made national headlines, that a Tuskegee Syphilis Study Advisory panel was created. The panel focused on the issue of informed consent and penicillin therapy. The subjects were not aware they were part of an experiment and were also misled on what the experiment really was about hence they were unable to have given informed consent (Brandt, 27). Commentary: Also, at the time of the experiment, arsenotherapy was considered to produce some good results in treating syphilis but the subjects were not administered this nor were they given penicillin when it was discovered. The panel ultimately concluded that the experiment unethical and the experiment was terminated.

Topic sentence: Let’s go back to the start of this experiment. How were the African americans convinced to partake in this experiment and what was the motive of some USPHS members. As previously mentioned, the social climate when the experiment was carried out was not the best for African Americans. A vast majority of African Americans were poor sharecroppers with little to no education, living as debtors under white landowners (Britt Rusert, 156). In addition, their living conditions were deplorable compared to poor whites. They had no running/clean water, electricity, or medical care and had higher mortality and morbidity rates due to the substandard living conditions they were exposed to.

Evidence & citing: Consequently, and in conjunction with other racist factors of the time, they were viewed as lesser citizens and constitutionally disposable. Therefore, many individuals in power believed that providing medical care for African Americans was a waste of already scarce resources in the Depression-era (Hagen, 32). This argument did not sit well with some members of the United States Public Health Service (USPHS), and they embarked on a mission to prove this argument wrong (Hagen, 32-33). Commentary: They aimed to show that, not only do African Americans contract the same diseases as white people, they also get sick in the same ways and at the same rates as white people.

Topic sentence: Keeping the above in mind, let’s look at this experiment through the lens of Aristotle’s triangle. The Greek philosopher Aristotle divided the means of persuasion appeals, into three categories – Logos, Ethos, and Pathos. Logos means persuading by the use of reasoning using facts, truth and logic. Ethos refers to the trustworthiness or credibility of the writer or speaker, and Pathos means persuading by appealing to the emotions of the audience.

Evidence & citing: Per Aristotle’s triangle, the logos of the situation was to portray African Americans as being just as human as white people. Other aspects of logos include the health data about the African American population – 50% of African American population in Alabama was infected with syphilis (Brandt, 22). In addition to that, there were so many negative assumptions made about the African American population which were also taken for fact especially about the mental and sexual capacities. Also, the morbidity and mortality rates of the black people constituted facts that caused the African Americans to get involved in the experiment.

The fact that the USPHS, a credible and trustworthy health authority and it’s member were involved, was the Ethos of the situation. Furthermore, the presence of prominent African American doctors and nurses like Nurse Rivers going around ensuring black participation, provided more credibility, as the African americans felt they were trustworthy. Evidence & citing: The Pathos – what appealed to this population’s emotions were the fact that they saw hope for their deplorable situation. The vast majority that had possibly never had a medical checkup now had ‘free’ and ‘great’ healthcare at their disposal – treatment for other illnesses and free burial after autopsy, upon death (Brandt, 24). Commentary: These were benefits several of those African Americans only dreamed of.

Topic sentence: Despite the general consensus that the experiment was evil, there is a different school of thought when it comes to the Tuskegee experiment. These people believe and state that the Tuskegee experiment was not all evil because it started off with good intentions, as mentioned above.

Evidence & citing: However, this argument is quickly crippled by a simple question – why was no white person included in the experiment? This does not encourage humane actions in any way. At the time, there were rural, poor whites living in similar (granted much better) conditions as their African american counterparts as Kimberly Hagen stated, “syphilis was epidemic among rural Southerners of all ethnicities, no safe or effective treatment for it existed” (Hagen, 33). They could be considered a financial burden as well, but they were excluded from the study. Commentary: Also, the claim that the intentions were so good fails to stand in the face of the fact that the subjects were not given penicillin as soon as it was discovered as a treatment for syphilis.

Topic sentence: Now, that the Tuskegee experiment has been discussed in depth, let’s explore its influence on modern day bioethics. Over the years, the definition and depth of the subject of bioethics has evolved drastically. Evidence & citing: Today, bioethics can be defined as “a discipline dealing with the ethical implications of biological research and applications, specifically in field of medicine” (Meriam Webster Dictionary). From surgical protocols to pharmaceutical research, bioethics has integrated itself into deep into each medical niche.

However, although the specifics of how bioethics is defined varies among different areas of medicine, bioethics stands upon a common foundation. Evidence & citing: According to Lisa M. Lee, in her recent article “Public Health Ethics Theory: Review and Path to Convergence,” she cites that bioethics stand upon four main principles: autonomy, beneficence, nonmaleficence, and justice (Lee, 86). Commentary: These four guiding pillars have come about in response to the events that have transpired over the years in the healthcare system, one of those arguably being the Tuskegee experiment.

Today, the Tuskegee Experiment acts as a reminder and an example of what can occur in the absence of standard bioethics, which can give way to personal preference, bias, and prejudice influencing the reason of a healthcare provider. In the 1930s, the Tuskegee Experiment blatantly defied the personal autonomy of their human subjects. The African Americans were not told of the full gravity and extent of the research of which they were part, denying the chance at autonomy with respect to their bodies and medical treatment. In modern medicine, there is an underlying goal of always doing what is in the “best interest of the patient.”

Conclusion

Conclusion paragraph: As seen in the dangerous, unprecedented treatments and practices that were inflicted upon the black community, the violation of interhuman beneficence was clearly disregarded in earlier years, which has served as fuel to enforce stricter adherence to that which the patient his or herself desires of their time under medical care if capable. Hand in hand with beneficence lies the concept of nonmaleficence.

Nonmaleficence encompasses the act of taking the safest way to ensuring full recovery, avoiding at all costs most harmful and harsh treatment plans unless absolutely necessary. As noted above, the actions that inflicted against the lower class African American subjects of the Tuskegee Experiment could be characterized as maleficent. The patients were outright denied access to syphilis medicine, allowing them to undergo the crippling effects of the disease which left the patients and their families with not only physical, but emotional damage as well.

From this experience, as well as others, modern medicine now stresses nonmaleficence to ensure that their patients right to life, liberty, and happiness are no longer violated during their time under medical supervision, but tended to, allowing all patients to receive the fair care at medical facilities around the nation. Lastly, is the principle of justice, providing just treatment, to patients also exists all of the main principles of bioethics. This principle relates the closest to the events surrounding the Tuskegee Experiment. Firstly, poor African Americans were the only subject used in this study.

Since they were poor and suffering with syphilis, they lacked the economic means to acquire better healthcare. As such, these subjects were taken advantage of as easy targets to take place in the experiment. Furthermore, only African Americans were used in this experiment. Due to the racial climate of the United States at the time, sentiments of prejudice and bias overtly affected the treatment of the subjects, as they received no justice.

It wasn’t until 1997 that the survivors of Tuskegee and African Americans as a whole received an official apology from then president Bill Clinton and funding was pledged to the National Center for Bioethics in Research and Health Care at Tuskegee University. As aspiring healthcare professionals, it is important that to know the history of the field, so future patients can be given proper care and their fears /concerns can be dealt with accordingly. Also, while the past history cannot be changed, it can guide in making future legislations, just like modern day bioethics principles were due to the unethical nature of studies such as the Tuskegee experiment.

References

1. “The Tuskegee Timeline.” Center for Disease Control and Prevention https://www.cdc.gov/tuskegee/timeline.htm (accessed on March 30, 2019).
2. Brandt, M. Allan. “Racism and Research: The Case of the Tuskegee Syphilis Study.” The Hastings Center 8, no. 6 (December 1978): 21-29. https://www.jstor.org/stable/3561468 (accessed on March 30, 2019).
3. Cambridge English Dictionary (2019). Apology. https://dictionary.cambridge.org/us/dictionary/english/apology (accessed on March 30, 2019).
4. Hagen, S. Kimberly. “Bad Blood: The Tuskegee Syphilis Study and Legacy Recruitment for Experimental AIDS Vaccines.” Wiley online library 2005, no. 105, (February 28, 2005): 31-41. https://doi.org/10.1002/ace.167 (accessed on March 30, 2019).
5. Hudson, Jennifer. “Logos and Logical Fallacies: Logos, Pathos and Ethos.” Lecture given in class on January 16, 2019.
6. Lee, L. M. “Public Health Ethics Theory: Review and Path to Convergence.” The Journal of Law, Medicine & Ethics 40, no. 1 (March 1, 2012): 85–98. https://doi.org/10.1111/j.1748-720X.2012.00648.x (accessed on March 30, 2019).
7. Meriam Webster Dictionary (2019). Bioethics. https://www.merriam-webster.com/dictionary/bioethics (accessed on April 10, 2019).
8. Rusert, Britt. “A Study in Nature”: The Tuskegee Experiments and the New South Plantation. Journal of Medical Humanities 30, no. 3, (September 2009): 155–171. https://link.springer.com/article/10.1007%2Fs10912-009-9086-4 (accessed on March 30, 2019).
9. Shamim M. Baker, Otis W. Brawley, Leonard S. Marks. “Effects of untreated syphilis in the negro male, 1932 to 1972: A closure comes to the Tuskegee study, 2004.” Science Direct 65, no. 6 (June 2005): 1259-1262. https://doi.org/10.1016/j.urology.2004.10.023 (accessed on April 10, 2019).
10. Walker, Charles A. 'Lest We Forget: The Tuskegee Experiment.' The Journal of Theory Construction & Testing 13, no. 1 (Spring/Summer 2009): 5-6. http://web.a.ebscohost.com.libproxy.utdallas.edu/chc/pdf?vid=4&sid=19295099-f7ac-44a4-a6d6-5ffaf74d9074%40sdc-v-sessmgr02 (accessed on April 19, 2019).