Bioethics- Tuskegee Syphilis Study

BACKGROUND FACTS
In the early 70s, the Washington Evening Star newspaper published this headline on its front page: "Syphilis Patients Died Untreated." (CDC) This headline revealed one of America's most dishonorable medical studies, the Tuskegee Syphilis Study. From this very moment, the public knew the long-hidden truth about this notorious study.
In 1932, the United States Public Health Service (USPHS) initiated the Tuskegee Syphilis Study. Their goal was to investigate stages in advancement of syphilis, a sexually transmitted disease caused by bacterium that may cause death if untreated. (CDC) Furthermore, the study wanted to investigate how syphilis affects blacks compared to whites. They hypothesized that whites experienced more neurological complications while blacks experience more cardiovascular complications.
The study used 399 poor black sharecroppers from Macon County, Alabama with dormant syphilis. An additional 201 healthy, unaffected men that were part of the study served as control subjects. Many bioethical values were largely violated. The physicians conducting the study misled the men from the beginning of the experiment. They purposely told men that they had “bad blood” and that they would treat them. Instead, these men were given a placebo. Physicians made sure that they did not receive treatment or help from anyone else. The reward for this “therapy” was free meals, free medical examinations and free burial insurance. It took more than 20 years to reveal the details of this famous Tuskegee Syphilis Study. Tuskegee became a symbol of discrimination in health treatment, ethical misbehavior in human research, and government abuse of innocent people that died in the name of the bad study and science. The entire Syphilis event fortified a fear of the African Americans toward white human race in medical and political institutions.
Public Health Services initiated many interventions in order to fulfill their study. They lied about the treatment and affected other medical institutions and doctors by making them disregard the sacred oath by which they are obligated to help a person in need. The research was not even conducted properly, showing many flaws and missing information. The length of the research was too long to give accurate results. Many test subjects did not cooperate with the requests made by doctors and nurses. Numerous men did not agree to autopsies while others migrated which clearly points to more invalid data necessary. The ones that moved out of Tuskegee received the proper treatment and were cured by doctors in those areas. One of the key doctors involved in this study, doctor Wenger, went even further and said that that the study subjects should be left to die in order to further study the effects of the syphilis. (Brandt 21)
The Tuskegee Syphilis Study ended in 1973 in Tuskegee, Alabama. Six hundred poor and mostly unschooled African-American males, out of which four hundred were infected with syphilis, were observed for 40 years. Untruthful examinations and placebos were given to these poor African American participants despite the discovery of penicillin, a cure for syphilis that became available in the 1950s. Nevertheless, the study proceeded until 1972, disregarding the proper treatment and existing medicine. Numerous participants died slow and painful deaths during this horrific study. Finally, the U.S. Department of Health, Education, and Welfare stopped it in 1973 once its existence became known to public and forever marked political shame.

VIOLATED ETHICAL ISSUES LEADING TO BELMONT REPORT PRINCIPLES
The abuse of African American by physicians was unfortunately not an uncommon or isolated case. A long time after the Civil War, which delivered, among other things, their freedoms; African Americans were still being discriminated against in medical treatments. There were cases where so-called “night doctors” hunted the African Americans in urban areas, captured them and sold them to physicians afterwards for further medical research. Many times, the victims would be killed and used as cadavers for further research. (Gamble, 1778)
Due to historical non-ethical treatments of blacks, many of the African Americans during all these years developed deep distrust toward whites in the government and medical institutions, which was topped with the famous Tuskegee study. The fear of mistreatment in research due to denial of proper medical care is widespread in the African-American population. It is not just paranoia. Earlier in the history, a surgeon named James Marion Sims, devised ways to repair vaginal injuries that can occur in childbirth, but he did that by performing numerous painful operations on the genitals of black female slaves.
The Belmont Report was a document made after the congressional intervention in 1979, by which it was now required that an individual and everyone else involved in human subject study to read and understand what is being done in the tests. According to the Belmont Report, there are three fundamental ethical codes regarding all human subject study, and these are veneration for human beings, beneficence, and integrity. First, respect for individuals obliges medical scientists to obtain informed approval from their research participants. These study participants must be given truthful information about their circumstances and treatment choices. Second, the beneficence means that all possible risks and benefits of the treatment, too, have to be clear and shown to test subjects. Lastly, the justice is important so that there is not any division present. The study participants should be chosen randomly and not based on their economic, racial, gender or social class. Researchers and doctors, therefore, have to be fair to everyone involved in the given study.
Scientists and doctors violated all three of these principles in the Tuskegee Syphilis Study because the study was not truthful from its very beginning. It was also biased, operating under the assumption that African Americans were more prone to the disease. Many were literally left to die for the sake of a poorly developed experiment. With serious devaluation of the human life shown in this experiment, one cannot argue if the benefit of the research ever justifies the unethical and discriminating behavior towards the human beings. Whether or not the test subjects were deliberately infected with syphilis still remains the unanswered question. There are many cases in the history that prove the unethical behavior in the name of science as well as misbehavior of whites toward blacks.
Some critics even compared the Tuskegee study to Nazi treatment of Jews. Physicians in Nazi Germany, from the year 1933 until year 1945, performed cruel experiments on human beings. Why they went so far was not because of the way people were treated during the experiment or war, in Hitler’s case, but because of the lack of value of the value of human life. These experiments were poorly designed and controlled, so they did not even contribute to the advancement of a science. (Lefor, 878) Hitler saw absolutely no value in the lives of Jews and thought of them as a biological threat, similar to researchers in Tuskegee devaluing the values lives of blacks. (WW2HISTORY.COM) Individuals that survived the study received a long awaited official apology from President Bill Clinton in 1997, 25 years later. (NYT)
Shameful, unethical treatments of human beings are seen even in this millennium. GlaxoSmithKline, a British drug company in collaboration with US Aids Clinical Trial Group, a clinical research network, performed HIV experiments on a hundred Hispanic and black orphans. (The Guardian) Human beings were again used as Guinea pigs.
The Tuskegee study is, nevertheless, a root of a fear that seizes very deep in numerous lives of African Americans today. This fear inhibits future efforts to conduct any research that would be beneficial to the health care and treatment for everyone, including African Americans. It is still deeply incorporated into African- American individuals. The study done in 1997 confirmed why African Americans refuse to participate in any type of the research. Many answered that they simply did not want to guinea pigs. (Corbie-Smith et al. 537)

PRESIDENT CLINTON’S APOLOGY
An apology is a first step to gaining a trust and faith. Rebuilding trust is never easy or instantaneous but rather a continuous process that takes years and a lot of effort. (CNN) President Clinton initiated that process with an apology it in 1997. It took four American presidents for that to occur. He said that he couldn’t undo what was done but that the silence should be ended by apology. That apology was preceded in 1995 by establishment of a National Bioethics Advisory Commission whose purpose was to review current policies, regulations, and procedures that would ensure the safety of research volunteers. Clinton continued with his effort to improve the human rights of every American Citizen. History usually repeats itself as shown from many recent events and the only way to change the outcome is to educate and prevent.

CATHOLIC CHURCH ABOUT THE HUMAN LIFE
The Catholic Church never officially discussed the Tuskegee Syphilis study. Nevertheless, the stand of the church would be clear. People are supposed to be stewards and not the owners of the life. It is not up to them to decide whether or not they will end another human being’s life including their own. (Catechism) The only master is the loving God. Syphilis study had no empathy, no compassion and no love--the supreme law in the Catholic religion. Christian morality forbids doing ill to one's neighbor, even to an enemy. The experiments that can only hurt are forbidden; those that are harmless are acceptable in certain circumstances and the ones that may be beneficial to person in need are morally obligatory.
Pope John Paul II, the leader of the Catholic Church, stated that the every human life is a part of the God’s loving plan. (BBC) Although not directly applied to the Tuskegee study, there is no doubt about how his words apply to this unethical study. According to Pope, free and virtuous societies should not have any practices that devaluate and violate human life in any way before a natural death.

CONCLUDING THOUGHTS
The Tuskegee syphilis Study was a shameful historical event that happened in 20th century. It is not the first case, but actions should be taken to prevent the future ones. There are too many cases of unethical treatment toward human beings seen in the history of the human race. In a way, the Tuskegee legacy connects any event in history where people have suffered: African- American slaves, Native American tribes, Holocaust victims etc. It is upon this generation to make more regulations and laws that will educate common people as well as prevent unethical and immoral individuals from becoming a part of the medical and political community. The love for another human being should be taught early in every school in this world. It is hard to change adult individuals with deformed moral and ethical values. Numerous organizations for human rights are a great step forward, but further investments and continuous nurture of these values have to support it. Sometimes the only thing, as President Clinton has said, is to apologize. It is a start, but it stays just the start if nothing is done about it. Justice will never be given to dead individuals and their families. The Tuskegee Syphilis Study moved from a shameful historical event to a symbol of racism and ethical misconduct in medicine and research as well as government abuse of helpless people. It is the moral obligation of an individual, whether or not that individual is a Christian, to help man a man in need.

Works Cited
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Barnett, Antony. "UK firm tried HIV drug on orphans." the Guardian. N.p., n.d. Web. 1 Nov. 2013.
Brandt, Allan M. Racism and research: The case of the Tuskegee Syphilis study. The Hastings Center Report. 1978. 8(6): 21-29. Print.
“Christianity: John Paul II.” BBC Religion.2011. Web. 5 November. 2013
Corbie-Smith G, Thomas SB, Williams MV, Moody-Ayers S. Attitudes and beliefs of African Americans toward participation in medical research. J Gen Intern Med. 1999 Sep;14(9):537-46.
Denise. "BOOKS; White Doctors, Black Subjects: Abuse Disguised as Research." The New York Times. The New York Times, 23 Jan. 2007. Web. 4 Nov. 2013.
"Final Report of the Tuskegee Syphilis Study Legacy Committee." Bad Blood The Tuskegee Syphilis Study. N.p., n.d. Web. 8 Nov. 2013.
Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health. 1997 Nov;87(11):1773-8. Print.
Lefor, Alan T.. "Scientific Misconduct And Unethical Human Experimentation: Historic Parallels And Moral Implications." Nutrition 21.7-8 (2005): 878-882. Print.
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Prater, Donathan. "Healing their spirits: Tuskegee Experiment heirs speak at panel discussion at Notasulga church." Opelika-Auburn News (AL) 18 Aug. 2007: Newspaper Source Plus. Web. 12 Nov. 2013.
"Respect For Human Life." Catechism of the Catholic Church. 2nd ed. Vatican City: Libreria Editrice Vaticana ;, 2000. 2270-2274. Print.
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