Case Application: TUSKEGEE STUDY

   Syphilis is a chronic, contagious bacterial disease that is most often sexually transmitted but is sometimes congenital. Since about 1946, the disease has been successfully treated with antibiotics. Prior to 1946, individuals with the disease had an inevitable progress through its sequelae, from the primary lesion and chancre to rash, fever and swollen lymph notes to the final stage of nervous system and and circulatory problem, and finally death. The progress of the disease is often 30-40 years.

    Around 1929 there were several counties in the South, with a high incidence of syphilis. The U.S. Public Health Service (USPHS) began a demonstration project to treat those afflicted with the disease in Macon County, Alabama, home of the famous Tuskegee Institute. With the Great Depression, funding for the project decreased and finally the demonstration project to treat the men became an opportunity for a study in nature. A study in nature means that the researchers were not to treat the patients rather were to observe the natural progression of the disease. To conduct this study in nature, the USPHS selected 399 African American men who had never received treatment.

    The research group was told essentially that they had "bad blood" and they had been selected for special free treatment. Except for an African American nurse, Eunice Rivers, there was very little continuity with staffing of the experiment, as the federal doctors would come every few years to check on the progress of the disease. To induce the participants, they were, promised free transportation, free hot lunches, free medicine (for everything but syphilis), and free burials.

    Although antibiotics were available in adequate supply by 1946, the study subjects were never treated. In fact, the local draft board was provided their names so that they could not enter the army, where they would have been treated as a matter of course. The local members of the county Medical Society were also provided their names and were asked not to provide them with antibiotics.

    In July 1972, Peter Buxtun of the USPHS, who had been criticizing the study since 1966, told the story to an Associated Press reporter, and the research became headlines across the nation. In 1997, President Clinton officially apologized to the remaining study participants in behalf of the United States government.

 

Answer the question:

1. Consider each of the individual basic ethical principles: autonomy, veracity, beneficence, non-maleficence, justice, fidelity and confidentiality. Which of these principles were sacrificed or violated in the Tuskegee study? (Give at least 3 ethical principles).

 

The Tuskegee study was totally unethical in practice . It was done to see the progression of disease rather than treating the disease . Considering each of the ethical principles :-

• Autonomy - African Americans were not given ability to take decision on their participation
• Justice - Justice was not given to them , they were denied of the treatment for syphilis just because of their need to see the progression of disease which was their study
• Beneficence - Opposite of beneficence was done to the patients suffering from syphilis . They were more harmed by not providing treatment
• Non - maleficence - only harm was done to the patients suffering from syphilis . They were providing false treatment to them for conducting their study
• Confidentiality - confidentiality was maintained
• Fidelity -the study people gave the patients blind faith about the treatment
• Veracity there was nothing true in this study. Everything was done for profit and in the best interest of the patients

Step-by-step explanation

The Tuskegee Study was a notorious clinical study on Untreated Syphilis conducted on the Negro Male. It is a racist and unethical medical experimentation taken placed during the period 1932 to 1972, nearly 400 impoverished and poorly educated African-American men diagnosed with latent syphilis (no obvious symptoms at this stage but they had the infection). The main aim of this unethical medical experimentation was to see whether syphilis affected black men differently from white men. Before the treatment they never told they had syphilis and were never treated for it. The participants were devalued due to their African-American background, exploited, uninformed about their own pertinent medical details, and effective, potentially life-saving antibiotic treatment was withheld. During these studies the institution offered free food, free rides and free medical treatment to participants and the medical staff allowed nothing to interfere with their work.

Nowadays global nature of health research was drastically increased and in particularly the conduct of clinical trials involving human participants, has highlighted a number of ethical issues, especially in those situations in which researchers or research sponsors from one country wish to conduct research in another country. International collaborative biomedical research have increased during the past decade, long-standing questions about the ethics of designing, conducting, and following up on international clinical trials have reemerged. The studies in question might simply be one way of helping the host country address a public health problem, or they might reflect a research sponsor´s assessment that the foreign location is a more convenient, efficient, or less trouble-some site for conducting a particular clinical trial. Some of these issues have begun to take center stage because of the concern that research conducted by scientists from more prosperous countries in poorer nations that are more heavily burdened by disease may, at times, be seen as imposing ethically inappropriate burdens on the host country and on those who participate in the research trials. They might also represent a joint effort to address an important health concern faced by both parties.  Some observers believe that market forces have pressured private companies to become more efficient in the conduct of research, which may absent vigilance compromise the protection of research participants. The potential for such exploitation is cause for a concerted effort to ensure that protections are in place for all persons who participate in international clinical trials.