Essay: The Tuskegee Study of untreated syphilis (bioethics)

The Tuskegee Study of untreated syphilis was one of the most horrible scandals of of the twentieth century. It was a clinical study conducted between 1923 to 1972 by the U.S. Public Health Service and the Tuskegee Institute in Macon County, Alabama. The purpose of the study was to record the natural course of untreated latent syphilis in black males. It was called the “Tuskegee Study of Untreated Syphilis in the Negro Male’. The study initially involved 600 black men ‘ 399 with syphilis, 201 who did not have the disease. The study was conducted without the benefit of patients’ informed consent. Researchers told the men that they were being treated for “bad blood,” a local term used to describe several ailments, including syphilis, anemia, and fatigue. In truth, they did not receive the proper treatment needed to cure their illness. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance. When penicillin became widely available by the early 1950s as the preferred treatment for syphilis, the men did not receive therapy. Although originally projected to last 6 months, the study actually went on for 40 years.
The central moral ethical issue to be considered is informed consent, which refers to telling potential research participants about all aspects of the research that might reasonably influence their decision to participate. The investigators took advantage of a deprived socioeconomic situation in which the participants had experienced low levels of care. It was never explained to the subjects that the project was designed to detect syphilis.
One side to the story is that the Tuskegee Study was a program of deliberate efforts to improve the health of poor African Americans in the rural south. (Munson,p.774).’ Syphilis was viewed much of the way Aids was when it made its appearance in the United States’. (Munson,p.774). By 1905 the bacterium was isolated and a year later a blood test was introduced for the disease. After hundreds of chemicals were tested as a hopeful cure, one was identified that seemed effective. They were hopeful that they had identified a drug that could eradicate the disease so that it would not continue to spread. In 1930, the sampling showed that 35% of the black community in Macon County, Alabama was infected with syphilis.The United States Health Services initiated a program to diagnose and treat 10,000 African Americans for Syphilis. By 1931 in the midst of the depression the Public Health Service had underestimated the cost of eradicating the disease and the funding ran out.
The other side of the story is that a gentleman named Taliaferro Clark of the Public Health Service was unsatisfied that the funding ran out and decided that even though there was no money for extensive treatments. He proposed to the PHS to do a six month study of the natural history of untreated syphilis at little cost (Munson,p.774). He was interested to explore whether the disease had genetic differences or if it behaved the same in blacks and whites. The PHS accepted Mr Clark’s proposal and endorsed a research program that involved deceiving black makes about the nature of their illness by deliberately withholding treatment but giving them the impression that they were being appropriately treated (Munson,p.775).The Tuskegee institute was then approached by the PHS with it’s research proposal and in 1932 agreed to participate with an observational study. The institute would be paid for its participation and its doctors, nurses and interns would have the opportunity to work for the government, a major incentive of the worst depression in the rural south (Munson,p.775). The subjects weren’t given any more specific diagnosis other than bad blood.
The study violated several ethical principles. autonomy, being that the subjects were never given informed consent or accurate information about their condition and treatment options so that they could decide what was in their best interest and what could happen to them. Also beneficence, research involving human subjects should do no intentional harm while maximizing benefits and minimizing harm. ‘We should act in ways that promote the welfare of other people’ (Munson,p.894). Lastly, justice applies here. ‘The central task of the government is to preserve and promote the liberty and welfare of individuals’ (Munson,p.880). Obviously, researchers in the Tuskegee syphilis study lied to their participants about their condition and the treatment they were receiving and were selected based on race, gender and economic class.
Although the intentions of the Tuskegee study was originally set up to help the impoverished, uneducated black males neither side of the argument is not justified. Its subjects were never granted the autonomy to make their own decisions. Sadly they ended up treating them as nothing more than experimental animals. I feel that this was a clear violation of medical practice and discrimination. The fact that these poor victims were deliberately misinformed about the nature of their illness is implorable and a violation of human rights.
Reference:
Munson,R. (2012). Intervention and Reflection Basic Issues in Bioethics. St Louis: Clark Baxter.