Ethics: Withholding Treatment in Tuskegee Study

Statement of the ethical issue and why it is of concern

Tuskegee experiment showed that withholding treatment from the research subjects was unethical. The researchers did not consider the interests of the 200 uninfected subjects who acted as the control group. In addition, the researchers did not offer any treatment to 400 subjects who had syphilis (Heintzelman, 2003).

The researchers ignored the welfare of the research subjects. However, they tried to justify their actions of withholding the penicillin treatment from the subjects. Some researchers believed that it was not necessary to administer treatment to the subjects because of delays. On the other hand, other researchers thought that it could result in complications associated with “fever, angina, and ruptured blood vessels” (Heintzelman, 2003). According to these researchers, such reactions to penicillin were riskier than the benefits of treatment.

During the Tuskegee experiment, there were no data on the effectiveness of penicillin as a cure for syphilis. In addition, information on both short-term and long-term toxic impacts of the drugs was not available. After periodical reviews, the researchers concluded that it was necessary to withhold the treatment. However, when the penicillin drug became effective and available for treating syphilis, the researchers denied subjects opportunities to continue with the study and treatment.

Other ethical issues also emerged in the Tuskegee study. There was also withholding information from the research subjects. The researchers did not inform their subjects about the study. Instead, they made research subjects believe that it was free medical care. The physicians wanted to see how subjects reacted to penicillin without treatment.

There were also no informed consents from the study subjects. In addition, subjects lacked information on the treatment. The study duration was also long. Researchers violated the Henderson Act of 1943. This Act requires informed consent from subjects and information on the consequences of the experiment on the subjects.

Historical summary of key factors related to the issue

Some studies indicated that this was “the longest non-therapeutic experiment on human beings in medical history” (Brunner, 2010). The United States Public Health Service (USPHS) performed the study from 1932 to 1972.

The subjects were 600 blacks from Tuskegee, Macon County of Alabama. Most participants (400) had a syphilis infection, and the rest (200) acted as the control group. The study aimed to determine the effect of syphilis on Blacks as professionals believed that whites suffered “neurologically whereas blacks experienced cardiovascular complications” (Brunner, 2010).

In 1932, researchers administered heavy metals to the subjects. However, in 1940, they denied their subjects antibiotic treatment when they established the safety and effectiveness of the drug.

During the 1950s, penicillin was widely available. However, researchers withheld both treatment and information from the subjects. Studies indicated that the USPHS intentionally prevented the subjects from receiving treatment (Brunner, 2010).

The USPHS published the first study result in 1936. The subsequent publications took place between four to six years until 1970.

In 1969, the Center for Disease Control Committee recommended that the experiment should proceed. However, in 1972, explanations of the experiment appeared in the press. Consequently, the Department of Health decided to change the study.

By 1972, more than 100 of the subjects had succumbed to “advanced conditions of syphilis, and 74 of the study subjects were still alive” (Heintzelman, 2003). The HEW investigatory panel established that the study was unethical. This led to the passage of the National Research Act of 1974. This Act mandated the Institutional Review Board (IRB) to approve all studies involving human subjects (Heintzelman, 2003).

In 1992, subjects (survivors) received compensation of approximately “$40,000 based on the agreement of the lawsuit filed on their behalf” (Heintzelman, 2003).

In 1997, President Clinton “publicly apologized to the study survivors” (Heintzelman, 2003).

How the issue is currently addressed in research

The Tuskegee study raised many important issues about ethical protections and rights of subjects in research. First, we have noted that the research subjects did not give their consent to the study. Researchers deceived them with promises of free treatment. Consequently, current studies require the informed consent of the subject. This involves provisions of full information, procedures, and risks of the study. The study exposed subjects to risks of harm from penicillin as there were no information on side effects and the effectiveness of the drug (Heintzelman, 2003).

Second, current studies demand that subjects must have the right to privacy. This is the promise of confidentiality. Researchers promise their subjects that people not directly involved in the research shall not gain access to study information. This should ensure the anonymity of the subject throughout the study. However, in the case of Tuskegee study, anonymity was difficult to sustain due to multiple studies and the extended length of the study.

Withholding treatment to the subject led to the issue of the right to service. This requires that control groups should not receive treatment during the study. However, if the treatment has benefits, then the control groups have the right to gain access to such services.

However, the existence of ethical standards and rules alone cannot guarantee subjects’ rights during the study. This is because research studies differ, and it may be difficult to identify possible ethical issues. In addition, there should be a guideline to ensure that researchers follow all procedures during experiments. As a result, most organizations have Institutional Review Boards (IRB). IRB considers all proposals concerning ethical issues and takes any necessary action to guarantee the safety and rights of the research subjects. This board also protects the organization and the researcher against any possible legal consequences.

The potential and or real impact on subjects and researchers

The consequences of Tuskegee study have been serious among the Blacks of the US. It created serious consequences for subsequent studies such as AIDS involving human subjects. The Blacks lost their trust in medical experiments, public health projects, and vaccinations.

Further, it also reinforced the idea of racism that was a subject of hate between the Whites and Blacks in the US. It showed that the medical practices at the time did not value the lives of research subjects.

Heintzelman observed that most Blacks did not seek treatment for AIDS during the 1980s because of the distrust that resulted from the Tuskegee study (Wynia, 2003). They did not trust “health care providers, diagnosis, and treatment of AIDS” (Heintzelman, 2003). To date, most Blacks think that they do not have access to the same standards of healthcare services as Whites. They also feel like the populations of the target in experimental studies as most of them are aware of the atrocities of the Tuskegee study. In all, the field of research has changed as all stakeholders have shown interest in protecting the rights of the human subject.

References

Brunner, B. (2010). The Tuskegee Syphilis Experiment. Web.

Heintzelman, C. (2003). The Tuskegee Syphilis Study and Its Implications for the 21st Century. The New Social Worker, 10(4), 1.

Wynia, M. (2003). Race, Trust, and Tuskegee: Professional Ethics, Broken Trust, and Health Disparities. American Medical Association, 1-24.

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