The Tuskegee Syphilis Study: An Overview

From the reading, it has been found that there is no particular difference between the meaning of ethics and morality but it is based on few philosophers who distinguish one term from the other [1]. Ethics can be defined as one’s belief on taking decision based on certain values at the time of taking judgment at some situation that has a moral reasoning behind the deed. In order to take an ethical decision, the person should have the correct morality in the mind. However, at the same time, the question of moral decision also varies from one person to another. At the time of taking any ethical or moral decision, there are many factors that play distinct roles. These factors can involve political opinion, social condition and any other strong belief behind taking a particular decision. This particular study aims at understanding the infamous incident of Tuskegee Syphilis Study from the view point of ethical decision and morality. In order to do so, a detailed analysis of the situation of the mentioned study shall be carried on in this paper.

The Tuskegee Study of Untreated Syphilis was conducted on the Negro male by the medical experts of US between 1932 and 1972. This was an infamous as well as unethical incident carried on with the purpose of observing the progression of the untreated syphilis in the rural African-American men in Alabama. The whole operation was conducted under the guise of the United States government to receive health care but there were other hidden intensions too. This was the reason that raised question on the ethical practice and morality of the developed nation like US. If the view point of Cohen is taken into consideration, it can be said that there are major opinions that are involved in pointing out a particular incident to be moral or ethical. In his write up he stated, “Of course, this is not to say that a person will always, in fact, act according to the decisiveness of the moral reasons; nor it is to say that a person would (or could) never act contrary to what they believe to be directed by moral considerations [1].” At the same time, the same situation might not be regarded as moral by someone else who has some other ethical opinion to share. The idea that the author wants to share here is that one can always declare their idea of ethical decision and indicate the situation that pertains to that decision. However, the ultimate decision of taking any step should be appreciated only when a mutual decision is taken and when we have heard the opinion from both the end. In case of the study of syphilis, similar approach was found because the Public Health Service of US started working to determine the correct dosage for specific people to treat their illness. During the experiment, 600 impoverished men were held and they were being given free medical care along with meals and a free insurance of their burial. In fact, this study was supposed to last for duration of 6 months but actually, this unethical study lasted for around 40 years [3]. In fact, the study was not very smooth and successful and it had resulted in the death of many people. The participants of the study were not even informed about their participation. The infected persons had no clue that they had the disease injected within them and they were told that they were being treated for ‘bad blood’, a disease that was taking lives of people in the southern African-American community [4]. This situation can be easily aligned with the morality and the aspect of impartiality that Cohen wanted to point out in his reading. According to him, moral opinions should be impartial and should not represent only one part of the situation and should be based on the overall situation.

Ethics and Morality in Decision-Making

At the same time, reading Rachels, the idea and concept of morality has also been made clearer. Rachels in his reading had pointed out several incidents where the concept of morality was questioned [2]. For example, in the case of Baby Theresa, when her mother wanted to donate the organs to other children who had the scope of living and would be benefitted with the transplanted organs, there were numerous opinions that went beyond her acceptance of donating the organ to the needy. There arouse the question on what was the need of killing and donating the organs of a person in order to save another live. Although, it was made sure that Baby Theresa will not be able to sustain her life for a longer time, yet people questioned on the morality behind early death or killing of a baby. From this, it can be said that when there is a question on the morality of a person, there has to arise some kind of debate in order to understand the perspective of both sides. As the reading says, “The question is whether taking Baby Theresa’s organs should be regarded as a justified exception to the rule [2].” However, in case of the infamous study of syphilis, there was no such moral arguments being made and it was considered to be unethical only after the whole operation was already conducted. The 40 year study had raised some serious ethical standards where the researchers failed drastically to answer the questions on the ethical standards. In fact, when the unethical practices of the study were revealed, it leaded to serious controversies on the validation of the research [4]. The researchers involved in the study did not use the particular penicillin as an effective cure against the disease but the patients were left untreated and to some extent, they were left to die.

Cohen had discussed the points of moral and ethics with several other examples. He has always been in the view that there should be arguments and counter arguments while taking any decision at the time of deciding an ethical and unethical situation. Justifiability is another concept that the author had put forward in his reading that implies the justification behind a particular act of being ethical or not. Over-rigidness is the similar concept that gives the weightage to the most significant value or the reason behind a particular situation to call it an ethical move [1]. There should be enough decisiveness and logic behind an approach and at the same time, it should not be doing any harm to any person. The point is that, it does not matter how complex is the situation, but there should be no wrong doing to anyone. For instance, the incident of the study of syphilis could have resulted in better welfare to the mankind if the people under observation were treated correctly. It was not only the men who could not survive, but there were women and children of those men who had to loss their lives in the unethical battle. There should have been law and legislations to mitigate the situation but unfortunately, the State did not take any action against this gruesome act and the victims were just left to die without proper and ethical intervention [2].

Impartiality in Ethical Considerations

There are other experiments as well that have taken place in different time in history when the researchers did not find it unethical to conduct research on human beings or other living things. The experiment conducted during the World War II by the Nazis was one of the most inhumane and atrocious experiment ever conducted. Human beings were treated as objects and they were kept in harsh condition and were inflicted to the possible pain as much they can bear. Questions were definitely raised on the grounds of ethics in conducting such experiments and resulted in more philosophical discussions as well. The unwillingness of the people and the expected outcome from the experiments on the improvement of the new medical science were largely debated. The researchers could never justify their act of determining the slightest possible ways in medical science against the inhumane and unjustified means of torturing men. Another example of such unethical and immoral practice that had taken place in the history can be discussed as well. The HeLa cell experiment was another milestone that the scientists wanted to achieve in the history of medical science. When Lacks arrived at the Hopkins Hospital with an issue of pain in her abdomen, she was diagnosed with cervical cancer tumour. However, her healthy cells were removed and that resulted in her death after 8 months. However, the scientists claimed that it was part of the study to understand and cultivate immortal cells in human body [3]. Researchers at times, justify their work and experiments saying that vaccines are available to fight against those diseases and in order to gain the knowledge of the vaccine, it is important to conduct social experiments on human being. In fact, there are many cases when the scientists have been successful in coming up with vaccines for life-saving diseases like small pox.

Analysing the infamous incident with the two readings on ethics and morality, if it is to be justified on what ground the experiment can be considered as justifiable, it can be said that experiments and practices can only lead to the situation of improving the mankind. The experiment received enough funds for the initiation of the process and in fact, although the subjects were black Africans, there were experience professionals as well who were actively involved in the entire experiment. The men under observation also agreed to the experiment and thus, there arouse no question in dealing with the unethical practice. In fact, in the beginning of the study, the men were given adequate treatment for their disease. On the other hand, there was no option given to the subject to quit the study according to their will even when more effective penicillin was available to treat the disease. In fact, there are many arguments that called the study as ethically justified because it helped in regaining much knowledge about the disease and its cure. In fact, as a part of the compensation of the issues, the US government also provided lifetime medical benefits to the living participants. There is no doubt on the ethical reason behind the starting of the experiment but the way how it was conducted lead to the various assumptions of unethical practices of the scientists along with the nation. However, willingness and the consent of the person matters a lot and it is absolutely important to understand the perspective of the person on whom the experiment will be conducted and then only the scientific proceedings can be justified with ethics and moral.

References:

[1] Cohen S. The nature of moral reasoning: The framework and activities of ethical deliberation, argument, and decision-making. Melbourne: Oxford University Press; 2004.

[2] Rachels J. The Elements of Moral Philosophy: Singapore: McGraw-Hill; 1999 (3^rd Edition)

[3] Evans NG. ethical and Philosophical considerations for Gain-of-Function Policy: the importance of Alternate experiments. Frontiers in Bioengineering and Biotechnology. 2018 Feb 8;6:11.

[4] Sulmasy DP. Edmund Pellegrino’s philosophy and ethics of medicine: an overview. Kennedy Institute of Ethics Journal. 2014;24(2):105-12.