In 1932 the federal government commenced a medical study called The Tuskegee Study of Untreated Blacks with Syphilis in Macon County, Alabama. Four hundred and twelve men infected with the disease were selected for the study that faked long term treatment while really only giving placebos and liniments. The goal of this study was to determine if blacks reacted similar to the whites to the effects of the syphilis disease. After forty years it was discontinued and the Senate initiated an investigation of the study. At the time of the investigation, only one hundred and twenty-seven of the study’s original participants were still alive and had not died from the disease (Morehan, 2007). In the film, the story is told from the view point of Nurse Eunice Evers, one key character in the movie, who played the role of the real- life nurse who was a part of the Tuskegee Study. The movie, Miss Evers’ Boys portrays “the emotional effects of one of most amoral instances of governmental experimentation on humans ever perpetrated” (Morehan, 2007). It depicts the government’s involvement in research targeting a group of African American males, as it explores the depths of human tragedy and suffering that result from unethical act. The film also unveiled the racial tension that existed in America which did not only occur in the segregation of skin color but also founded upon disease (Morehan, 2007).
The purpose of this paper is to analyze the film in order to critically examine bioethical issues in healthcare, research, and nursing. This paper focuses on the ethical frame-works virtue based ethics, right based ethics, justice based ethics, duty based ethics and it also reveals the roles and behavior portrayed by the main characters and also that of the scientific community and society.

Summary of Film
The film begins with Eunice Evers, an elderly nurse reciting the nurses’ oath to protect the health of those in her care as she testified before the 1973 Senate subcommittee who claimed that their goal was to discover the truth underlying the Tuskegee study and the hearing concerning Nurse Eunice involvement in the study. Miss Evers compares her struggle with her ethical and moral beliefs and the unethical issues presented in the study as climbing a series of mountains. Her challenge as presented in the film depicted her as a victim of the study instead of one that inflicted harm, because throughout the film she was seen as one who sacrificed the best years of her life to act as an emotional caring support system for the participants taking part in the study.
The movie progress through a series of flashback describing what transpired during the forty years she was involved in the study. In the beginning, Miss Evers supported the goal of the initial plan, which was to provide care and treatment to those suffering from syphilis. She believed that “it was the dawn of a new day”, and she was excited that the government had send her patients and her city the best funding and medical support available. She was enthused by it and did an awesome job gathering patients to seek treatment. Miss Evers was also able to convince a long lost school mate Caleb and his friends who named their folk music and dance band after her, Miss Evers’ Boys to come and provide samples to be tested. As the film progressed, it revealed that all of Miss Evers’ Boys were tested positive for the syphilis disease. At this point in the movie, active treatment was provided to all men who believed that “bad blood” was the cause of the disease.
Eventually, the funding for the initial study disintegrates. After a visit to Washington, various doctors confronted Dr. Brodus, the head doctor in Tuskegee, accompanied by Dr. Douglas the whit doctor with an offer for a new rationale for funding. The doctors explain their intentions of studying the African-American population, similar to the way a Caucasian population in Norway was studied in the Oslo Experiments. They were proposing the study involve untreated African-Americans dealing with syphilis. To convince Dr. Brodus, the doctors from Washington who apparently represents the federal government promised future treatment and proclaimed the future potential of the Tuskegee Experiment. This idea appealed to Dr. Brodus’ pride and he agreed to be at the forefront of the study naming it The Tuskegee Study of Untreated Syphilis in The Negro Male.
Over four hundred men tested with syphilis were selected to participate in the study which included Miss Evers’ Boys. Through her deceit, Miss Evers convinced the men to participate in the treatment which only included placebos and liniment. Throughout the duration of the study, the researchers which included the doctors, Dr. Brodus and Dr. Douglas; Nurse Evers and the federal government failed to fully explain the nature of the research to the victims; deceiving the participants telling them only that they had bad blood and not telling them that active treatment was being withheld from them.
Though, Miss Evers was burden with the ethical issues of the study, she continues to help Dr. Brodus conduct the study. As time passed six months turn into years, Miss Evers was in disbelief and shocked when she realizes that the men will not be treated, but she could not abandon them. In spite of her concern, she was once more convinced by Dr. Brodus to continue to hide the secret behind the study. She urges the men to continue the study, in hope of future treatment, a treatment that never came, even after penicillin became known as the drug t treat syphilis. Dr. Brodus and D. Douglas attempted to justify their role in the deception and withholding penicillin when it became the standard treatment for syphilis as a break through study for medical research. With the introduction of the penicillin shot, Caleb Miss Evers love interest rebelled, took the shot and enlisted in the army; whereas, the study continued and the other men were denied treatment. Against her father’s advice, Miss Evers refused to leave Alabama with Caleb who offered her marriage and continued to in the lie that encouraged the men to remain untreated. By the time this study was finally exposed and make known to the general public, only one hundred and twenty-seven men of the original study group were still alive and only two for Miss Evers’ Boys had not died from the disease.
At the end of the film, the Senate subcommittee that is obviously a part of the government attempt to criticize Miss Evers and the Tuskegee medical staff rather than taking responsibility for their own indiscretion of supporting such an unethical study and letting it continue for so long without examining its ethical legitimacy. In a very heart wrenching and moving speech before the subcommittee, Nurse Evers describes her sacrifice and personal compromises in order to serve as caregiver and primary source of emotional support to the dying victims.
Virtue Based Ethics
Virtue based ethics, sometimes called character ethics represents the idea that individuals’ actions are based upon a certain degree of inborn moral values. The virtue base which is a character trait that is socially and morally valued includes honesty, compassion, discernment, integrity, trustworthiness and prudence. Thus, if an act is not founded on good intention, no matter how kind or generous it may appear it cannot be considered to be virtuous (Burkhart, 2002).
Nurse
Virtue based ethics was portrayed in the irony of Nurse Evers reciting the nurse’s oath that she took as a nurse” I devote myself to the patients that are entrusted to my care” when in reality she was more devoted to the study and following the orders of her superiors, Dr. Brodus and Dr, Douglas. She did not prove to be a virtuous nurse, though it seems as if her intentions were good and appeared to be a compassionate person; she did not uphold the other character traits that a virtuous nurse should possess.
The main agent of dishonesty and lack of integrity in this film was Nurse Evers. Caleb, a participant of the study and also a friend of Nurse Evers whom a virtuous nurse would hold in high esteem because of his knowledge seeking attitude was the only one who refused to be deceived by Nurse Evers’ persistent desire to please her superiors. After the test results came, the curious Caleb insisted that he must know if he had tested positive for the syphilis disease. Not only did Nurse Evers tell him that he had the disease, she also told him the name of the other men who had been tested positive. She tried making to make up for the lack of professionalism by encouraging Caleb to lie and not tell the other men what she told him. Not only did she break the oath of confidentiality that is required by her as a nurse, she also showed no integrity as a nurse. She said that they need to trust the doctors because they knew what they were doing, and it is all for the best. Though the film showed Miss Evers’ constant battle with the ill intention of the study and her desire to do what is good for her patients, she never used discernment to walk away or reveal the truth to her patient about what the study was really about and what was being done to them. Instead, she submitted to the doctors’ request to lie to the patients.
Physician
From the beginning of the film, it was the intention of the whole team, especially Dr. Brodus to deceive the patients. This was clearly observed when he asked Dr. Douglas if it was in his plans not to tell the men that they had syphilis. To encourage this dishonesty, Nurse Evers said that it would be best if they did not tell the men that they had syphilis but to tell them they had “bad blood”. She explained that telling them that they had “bad blood” would not scare them and would be the best thing to do. The doctors justify their lack of virtue by believing it is okay to lie as long as the patients understood that this medical team along with the government only wanted to see them get well.
According to Burkhardt and Nathaniel (2002), a person with “integrity has a consistency of convictions, actions, and emotions and is trustworthy... [and it] means soundness, reliability, wholeness, and an integration of moral character” (p.36). It was constantly said throughout the film that the doctor must be trusted because the doctor knew what’s best. Indeed, they did know what is best but they used that to take advantage of the patients (they sworn to cause no harm to) for their own gain. That conveyed a lack of integrity and compassion. The doctors were not concerned with the wellbeing of their patients even when they began to witness the suffering and pain that their actions were causing the men. This uncompassionate behavior was observed at the end part of the film when Willie, one of Miss Evers’ Boys body began to deteriorate from the disease and was losing his ability to dance. Dr. Douglas, who knew how important dancing was for Willie, witnessed his decline and weakness did not have compassion enough to discern that he and his team members’ actions were wrong.
Society
The South was the section of the United States that most resembled the underdeveloped nations of the world in the 1930s. Its people, white and black, remained mostly rural; they were less well educated than other Americans; and they made decidedly less money. As a group, black Americans in the South were among the poorest of the poor. Indeed, they were chronically unemployed or underemployed, many living in shacks without benefit of sanitation, adequate diet, or the rudiments of hygiene. As a group, they did not enjoy good health. Many suffered from a host of diseases, including syphilis and their death rate far exceeded that of whites.
Despite their chronic need, few blacks received proper medical care. Many blacks never had access to modern medicine, going from cradle to grave without ever seeing a physician. There was a severe shortage of black physicians throughout the South, and many white physicians refused to treat black patients. In addition, there were only a handful of black hospitals in the South, and most white hospitals either denied blacks admission or assigned them to segregated wings that were often overcrowded and understaffed. Poverty was as much to blame as racism for the medical neglect of black Americans during the 1930s. Medical care at that time was offered on a fee-for-service basis, and many black Americans did not have the money to pay for health care (Jones, 2009). The men of Tuskegee were not eager to receive treatment at first. They asked Nurse Evers if a white doctor sent her and she replied that a black doctor had sent her to provide care free of charge. Nurse Evers had to bribe the men to participate in the study and to receive treatment. The study was founded on a lie from the beginning, Dr. Douglas states that “you people have the highest concentration of Syphilis in the country”, not only was that a display of racism in his choice of words, it also showed that it was common belief among society particularly the white population that black people were more susceptible to the disease. This belief was not grounded in truth because there was no proven fact with statistics that showed that claim as stated by Dr. Brodus. The government virtue based ethic was questionable by apparently using assumptions as facts.
Scientific Community
Trustworthiness is a confident belief in and reliance upon the ability and moral character of another person. It entails a confidence that another will act with the right motives in accord with moral norms (Burkhart, 2002). After the funds had ran low, Dr. Douglas convinced Dr. Brodus to meet with a group of doctors in Washington to discuss how they can receive funds to support the program. This group of doctors lied about the federal government funding the study. Even Dr. Douglas was in support of this deceit; he along with the other doctors eventually convinced Dr. Brodus (who was a little skeptical at first with the idea) to spearhead the dehumanizing study. It was never the intention to receive any money for treatment and the federal government that should strive for the betterment of its people whether they’re black or white was primary supporter of this heart-wrenching act at the expense of the innocent men that trusted them whole-heartedly. The federal government deceived the participants and the community as a whole through Dr. Brodus, Dr. Douglas and Nurse Evers who after becoming aware of the fact that the men were not going to receive treatment continue to act dishonestly. They are equally wrong as the federal government for approving and supporting the study. Trustworthiness was violated and abused to the fullest extent by all the main characters behind the study. Throughout the film it was observed that virtue based ethics was not maintained neither by the medical team that cared for the men nor the federal government that supported the study.
Right Based Ethics
This theory is based on upholding an individual's human or legal rights, such as the right to choose, the rights to autonomy (Burkhart, 2002). In the film, none of the medical team upheld the right of the patients. It is the duty of both the nurse and the doctors to have respect for the value and uniqueness of each individual. Genuine regard and respect for others should serve as a foundation of any caring profession. When patients are valued, they are allowed to be autonomous beings that have freedom to make choices about issues that affect their lives. Autonomy is a state where individuals are free to choose and implement their own decisions without lies, restraints, or coercion (Burkhart, 2002). The opposite of this definition of autonomy was also observed in the film. The men was not giving the choice to choose whether they wanted to participate in the study and they were deceived as and robbed of information about the true nature of the study and their disease.
Nurse
Miss Evers also played a role in the vulnerability of this population. In the beginning, she felt the privilege that the government had considerate her community for treatment. So she went out and gathers patients for the treatment. Many persons refused and said that they were not going to participate. She used bribery by promising to take the band to the dance competition in the government car and promise them hot meals if they decide to participate in the study to receive treatment. This act portrayed by Nurse Evers is considered unethical and does not uphold to the principles of ethical research. Human study participants has the right and is entitled to be told the truth, the benefits and the risks involved with the study that they willingly choose to participate in. none of this occurred in the film.
Physician
When the funding for the study had depleted, the doctors went to Washington to ask for more funding. The doctors there made it seems as if they were doing the Black population a favor; they were them an opportunity to prove that there was no segregation on how diseases affects the different races. Dr. Douglas saw that this study has an opportunity for Black doctors and nurses to be regarded as being well equipped and knowledgeable as Whites to conduct a survey that can make history. As Dr. Brodus faced this ethical dilemma, he did not consider his patients’ rights to be told the truth; the rights to be given freedom of choice or the right to access healthcare and treatment when it was made available. Instead, both doctors decided to feed of the men’s vulnerability for their own selfish gain to make history. They denied the patients’ rights to the truth, rights to autonomy and rights to be treated. This was seen many times throughout the film when Dr. Brodus and Nurse Evers repeated the phrase “you must trust the doctor, because he knows best, because he cares”. The healthcare team never expected to be questioned by their patients.
Society
According to American Nurses Association Code of Ethics, nurse is required to “provide services with respect for human dignity and the uniqueness of the client, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.” It is obvious that neither the doctors conducting the study nor Nurse Evers were committed to this principle especially when one of the patients went to another clinic to get the penicillin but his name was on the black list (Nursing World, 2010).
Scientific Community
The Tuskegee Syphilis Study was conducted under the supervision and support of the Public Health Service (PHS), which is obviously a department under the monitoring of the Congress. The government singled out this population to be subjects of this study because of their vulnerability as a poor community, the black color of their skin and the lack of education and the mere fact that they could not afford medical care. They were never given the choice to choose whether they want to participate in this study and the government did no conduct checks to consider the ethical part of the Tuskegee study. The doctors and nurses that were involved in the study did not see anything ethically wrong with what they were doing.
Justice Based Ethics
Justice is the ethical principle that relates to fair, equitable, and appropriate treatment in light of what is due or owed to persons and within the context of health care ethics, the relevant application of justice based ethics focuses on distribution of goods and services (Burkhart, 2002). Penicillin was discovered as the drug to treat the syphilis disease but yet the men were not given the drug. Instead they were denied the drug.
Nurse
Miss Evers insisted that the men received the penicillin shot but the doctors refused; they denied her access to the drug because they feared that she would give it to the men. She was shocked when it was brought to her attention that the men were never going to get treatment and that the doctor’s goal was to validate their point about the effect of syphilis through autopsy. After observing the toil that the disease had on Hodman one of her patient and friend, Miss Evers stole a vial of penicillin shot and tried to treat him, but being in the latent stage of the disease and mentally compromised Hodman poisoned himself with turpentine. Nurse Evers believed that the team was sacrificing the patients for something that she could not stand for and yet she continued to keep the study a secret from the participants in the study.
Physician
When Nurse Evers pleads on behalf of the participants, Dr. Brodus shouts back in anger: "You think you're the only person who feels? You got your burden and I got mine. You serve the race in your way. I serve it in mine. I can't rock the boat while I'm trying to keep a people from drowning". Dr. Brodus mentioned to Nurse Evers that they men will never understand the reason that is greater than anyone of them. Denying them treatment now was for the good of the race. To prevent the uninformed and uneducated men from seeking treatment elsewhere, the doctors further deceived them by saying that the drug would cause severe adverse side effect that will result in death.
Society
White hospitals frequently refused treatment to blacks. This was portrayed in the film where Caleb took Willie to the clinic to get the penicillin shot. The nurse at the clinic asked for Willie’s name and refuses him the shot when she found out that this name was on the list. When the men stated that they were going to get the shot at another clinic, the nurse told them that their names was posted around the city to other hospitals as a list of people to prevent from receiving treatment.

Scientific Community
The men were treated unfairly by the whole research team including the government for failing to investigate the nature of the study before fully approving it and especially by Dr. Douglas and Dr. Brodus who refused to give the patient treatment when it was available.
Duty Based Ethics
Duty Based Ethics is based on duty, responsibility, accountability, or obligation. Duty based ethics are concerned with what people do, not with the consequences of their actions. Under this form of ethics, actions cannot be justified just because it produces a good consequence or outcome (University, 2015). Every medical doctor should be knowledgeable about the Hippocrates oath that states that the doctor’s duty is to “first do no harm”.
Nurse
Although Miss Evers’ concerns about the goals and requirements of the study including the lack of informing the patients of their conditions and treatment for syphilis was conveyed throughout the film, Miss Evers thought her primary obligation as a professional nurse was to follow the orders of the doctors. On the contrary, according to the American Nurses Association (ANA) Code of Ethics, a nurse is required “to protect the public from misinformation and misinterpretation and to maintain the integrity of nursing” (Nursing World, 2010). Nurse Evers’ violated this principle by misinforming the patients about their real medical status and hiding information that there was no treatment for the syphilis even when penicillin became available. At that time, Nurse Evers’ seem to be motivated by a need to belong to the group of medical team by complying with the medical norms and rules of that present time. She lacked the accountability and judgment because she believed that the doctors could do no wrong and what they were doing had to be right. This was revealed in the film in her statements that the doctor knows best. She let her reasoning on sympathy and feelings to outweigh her responsibility to advocate for the rights of the patients to be treated fairly and be given treatment.
Furthermore, the ANA Code of Ethics explains that “the nurse collaborates with members of the health professions and other citizens in promoting community and national efforts to meet the needs of the public” (Nursing World, 2010). Nurse Evers patients were in need of medical treatment but she and the doctors failed to recognize this fact and Miss Evers displayed her lack of accountability by failing to adhere to the interest of her patients and the community at large. Even several years after the study had been discontinued; Nurse Evers refused to believe that it had caused harm to the men. The only ethical problem with the study that existed in Miss Evers eyes were the fact that the patients were not told directly and clearly that they had syphilis. She also believed that she had achieved her needs through meeting the needs of the patients as well.
Physician
Dr. Brodus and Dr. Douglas along with the doctors in Washington saw absolutely nothing wrong with carrying out a study that denied its participants not only the right to know the truth but the right to treatment; which was considered a great harm. At the beginning of the movie, Dr. Brodus was shown to be sympathetic with the patients but later he violated and failed to fulfill his duties and obligation as a physician to consider first the well being of his patients. It was his responsibility to maintain an accurate and honest relationship with the patients by providing them with information about the actual medical diagnosis and the true nature of the study but instead, he deceived his patients.
Dr. Brodus was influenced by the doctors in Washington to choose achieving personal gain and selfish benefits by approving the study to continue and depriving the patients from getting the available treatment instead of undertaking his obligation as a doctor. It is the responsibility of the doctor to refrain from denying treatment to patient because of a judgment based on discrimination, which was violated throughout the whole study.

Society
After the study was exposed and the subcommittee deemed the study unethical and unjustified, a lawsuit was filed on behalf of the study participants and their families. As a form of justification for their actions, the government allotted monies to the remaining survivors of the study and promised to give then lifetime medical benefits and treatment and burial services to all the living participants. Society as a whole failed their duty and responsibility to the participants provide care regardless of race, color and socioeconomic status. This was proven in the movie when Nurse Evers made the statement that if the study was conducted on a white population, the government would have stopped it a long time ago and would have provided treatment for the participants a long time ago but because the study was conducted on the Black population, nobody cares and said anything about it.

Scientific Community
The government and the Senate subcommittee that was conducting the hearing in the movie were not faultless. They also did not up hold their duties and obligations to participants in the study. It could be assumed that the study was not a secret to any of the men that sat on the subcommittee seeing that it had been presented previously to many professional conferences and panels before in was approved and sponsored by the government. The researchers including the federal government saw the responsibility they possessed in this matter was seek and achieve certain medical results regardless of its effect on the patients. Their duty was to care about helping to restore health and well being among the men and other members of the community in all fairness without discrimination of race or socioeconomic status. They neglected their obligations to care in sake of achieving scientific medical results, which in turn violates all ethical principles of research. Even though the subcommittee found that the study was unethical, no one was brought to justice for the inhumane way that the participants were treated. Instead, they treat to blame on Nurse Evers for what was going on.
Conclusion
The goal of this movie was to portray one of the most disastrous and unethical instances of human experimentation in history, in order to exam and understand the emotional consequences that resulted. It points out the length an unrestrained government may go to confirm a scientific idea and its desire to prove a connection between race and syphilis- a connection that was never there. The movie also did a good job of pointing out the deep gap of ignorance separating the study group from the investigators. At no point of the study did any of the patients question Miss Evers or the government. They knew nothing of their disease; the causes and treatment were unknown to the patients. This absence of knowledge between the government and the participants allows the progression of the study to continue. The movie points out the need for scientific integrity and education that must accompany such studies of humans and provides an example of why research while supporting the common good should be carried out in a purposeful and moral way.