Ethical Implications from the Tuskegee Syphilis Study
Dr. Joseph Costa, D.H.Sc., PA-C
Health Policy and Management
MPH 525
Allison Erickson
April 2013
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Table of Contents
Chapter
Page
1. Introduction ................................................................................................................................. 4
Ethics and Human Rights ............................................................................................................ 4
General Ideology ..................................................................................................................... 4
Four Principles ......................................................................................................................... 5
2. Tuskegee Syphilis Study ............................................................................................................. 7
Background ................................................................................................................................. 7
Cultural Influence .................................................................................................................... 7
Origins of the Study................................................................................................................. 8
The Study Itself ........................................................................................................................... 9
Selecting Subjects .................................................................................................................... 9
Methods Used ........................................................................................................................ 10
The Results and Implications ................................................................................................ 11
3. Implications of the Tuskegee Study.......................................................................................... 14
Future Repercussions ................................................................................................................ 14
Reduced Trust ........................................................................................................................ 14
Examples of the Mistrust ....................................................................................................... 14
4. Current Ethical Guidelines for Research .................................................................................. 16
Belmont Report ......................................................................................................................... 16
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Basic Ethical Principles ......................................................................................................... 16
5. Summary ................................................................................................................................... 18
6. Recommendations ..................................................................................................................... 19
References .................................................................................................................................... 21
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Chapter 1
Introduction
Ethics and Human Rights
General Ideology
The basis of morality, ethics, and human rights began its modern development during the
Holocaust and World War II. Events like these were a catalyst for the development of the United
Nations. In 1948, the United Nations created the Universal Declaration of Human Rights in
which it became an international human rights instrument (Nixon & Forman, 2008). Within this
declaration, the rights and freedoms were expanded in the International Covenant on Civil and
Political Rights, as well as the International Covenant on Economic, Social and Cultural Rights.
In addition to these, there have been over 100 human rights instruments added. “Through these
iterations, international human rights have come to be characterized as universal, indivisible,
interrelated and interdependent” (Nixon & Forman, 2008).
Human rights, internationally, focuses on protecting the dignity, equality, and unalienable
rights of all people (Nixon & Forman, 2008). “This focus translates into an abiding attention to
the poor, vulnerable and marginalized – those people routinely excluded from the benefits and
opportunities of the political, economic and social mainstream” (Nixon & Forman, 2008).
Additionally, the philosopher Peter Singer has expressed that all individuals capable of helping
other in preventing physical and mental harm, must (Eleftheriadis, 2012). Singer stated his moral
principle by saying,
If it is in our power to prevent something bad from happening, without thereby
sacrificing something of comparable moral importance, we ought to morally do it.
By ‘sacrificing something of comparable moral importance’ I mean without
causing anything else comparably bad to happen, or doing something that is
wrong in itself, or failing to promote some moral good, comparable in
significance to the bad thing we can prevent. (Eleftheriadis, 2012, p. 272).
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This statement made by Singer emphasizes that the distance separating us from other individuals
does not become relevant when a moral duty is required. “So he includes that ‘we cannot
discriminate against someone merely because he is far away from us” (Eleftheriadis, 2012).
Four Principles
Judgments, decisions, and actions made by leaders in any field rely on the four principles:
Respect for persons, beneficence, nonmaleficence, and justice. Within respect for persons, there
are four different elements including autonomy, truth telling, confidentiality, and fidelity.
Autonomy “requires that one act toward others in a way that enables them to be self-governing.
Basically, this is that right to be left alone” (Burke & Friedman, 2011, p. 91). This can be both a
negative and a liberty right. Negative because an individual can refuse treatment, a liberty right
because an individual can choose to be free from interference. However, the liberty right of
autonomy is inviolable as long as the choice does not interfere with rights of other persons.
Burke and Friedman (2011) indicate, “…the law recognizes that individual (liberty) rights cannot
be allowed to put society at risk, generally” (p. 91). When pursuing a course of action,
individuals need to be rational and uncoerced. Though, when an individual has limited rational
thinking from a mental or physical condition that can leave the person without much autonomy.
Nonetheless, these individuals are owed respect and provided means for expressing autonomy. In
regards to any treatment, autonomy is the underlying factor behind consent for the treatment.
The second element of respect for persons is truth telling. Although fairly selfexplanatory, truth-telling requires the honesty of leadership and subordinates. Even if the truth
hurts and individual, it must happen. Kantians believe that it is a sign of respect to be truthful.
“Loss of trust because of lying would bring into being much more ungood than good” (Burke &
Friedman, 2011, p. 91). Thirdly, confidentiality requires that leaders keep secret what has been
learned about those being served. However, there are legal requirements that morally justify
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exceptions to confidentiality. “Ethically (and legally), information can be shared only on a needto-know basis” (Burke & Friedman, 2011, p. 91). Lastly, the fourth element of respect for
persons is fidelity, which is the duty one has at keeping one’s word. This element is often times
related to promise keeping. As stated by Burke and Friedman (2011), “Keeping one’s promises
and being faithful in our relationships and interactions not only treat persons with respect, but
further the delivery of services” (p. 91).
Beneficence receives its roots from the Hippocratic tradition, “and is defined as acting
with charity and kindness” (Burke & Friedman, 2011, p. 91). The balance of benefits and harm is
the framework of this principle. Leaders are called to do all that can be done for persons served
under beneficence and to act in the best interest of those being served. Nonmaleficence also has
roots in medicine and can be defined as doing no harm. Although nonmaleficence allows for
specific moral duties and rules, there are some exceptions of doing no harm. For example, with
consent, a medical professional may need to inflict harm to avoid more serious harm or would
compromise truth telling if the truth would cause more physical and/or mental harm to an
individual. Lastly, justice has a plethora of definitions that are personal and collective
definitions. “Aristotle defined justice as equals being treated equally, and unequals being treated
unequally – a concept common to public policy analysis” (Burke & Friedman, 2011, p. 92).
Justice is also defined as fairness. Because of the vast number of definitions, leaders act justly
through the application of treating subordinates equally.
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Chapter 2
Tuskegee Syphilis Study
Background
Cultural Influence
(Note: the words and phrases used in quotations in the following sections do not reflect
the views of this author.)
At the turn of the 20th Century, American racism had a new rationale provided by
Darwinism. “Essentially primitive peoples, it was argued, could not be assimilated into a
complex, which civilization. Scientists speculated that in the struggle for survival the Negro in
America was doomed” (Brandt, 1978, p. 21). Using census data, social Darwinists predicted the
extinction of African Americans throughout the 20th Century, for which it was believed that the
African American race would be subject to degenerative evolutionary process. Biologists,
anthropologists, and ethnologists supported these findings through the later 19th and early 20th
Centuries. Brandt (1978) indicates, “Physicians studying the effects of emancipation on health
concluded almost universally that freedom had caused the mental, moral, and physical
deterioration of the black population” (p. 21). Dr. W.T. English was quoted saying, “A careful
inspection reveals the body of the negro a mass of minor defects and imperfections from the
crown of the head to soles of the feet…” (Brandt, 1978, p. 21). Many physicians agreed with
English’s analysis by including that the wide nasal openings, receding chins, and projecting jaws
left African Americans as one of the lowest species in the Darwinian hierarchy.
The sexual nature of African Americans became the central focus in racial differences.
One physician noted in the Journal of the American Medical Association that, “The negro
springs from a southern race, and as such his sexual appetite is strong; all of his environments
stimulate this appetite, and as a general rule his emotional type of religion certainly does not
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decrease it” (Brandt, 1978, p. 21). The sexual practices of the African American community
were deeply scrutinized with southern physicians promoting castration instead of lynching for
sexual crimes committed by an African American individual.
According to these physicians, lust and immorality, unstable families, and
reversion to barbaric tendencies made blacks especially prone to venereal
diseases. One doctor estimated that over 50 percent of all Negroes over that age of
twenty-five were syphilitic. Virtually free of disease as slaves, they were now
overwhelmed by it, according to informed medical opinion. (Brandt, 1978, p. 22).
Doctors believed that treatment for diseases like syphilis among the African American
population were impossible because in latent stages of infection, symptoms are rather quiet. With
quiet symptoms in latent stages, physicians believe that even the most educated African
American would not seek treatment for syphilis. Additionally, at the turn of the century many
doctors attributed low birth rates, high miscarriage rates, and high crime and insanity rates to
syphilis. The configuration of these ideas created a core medical opinion concerning African
Americans, sex, and disease in the 20th Century. “Doctors generally discounted socioeconomic
explanations of the state of black health, arguing that better medical care could not alter the
evolutionary scheme” (Brandt, 1978, p. 22). All of these assumptions created the backdrop for
the Tuskegee Syphilis Study.
Origins of the Study
In 1929, the United States Public Health Service (USPHS) conducted studies rural
communities in Southern America exploring the prevalence of syphilis among African
Americans the possibility of mass treatment. These studies were under a grant from the Julius
Rosenwald Fund. The highest rate of syphilis in a six county radius was in Macon County,
Alabama, in which the town of Tuskegee is located. Dr. Taliaferro Clark, the Chief of the
USPHS Venereal Disease Division and the author of the Rosenwald Study, concluded that the
syphilis conditions in Macon County merited attention. “Clark believed the high prevalence of
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syphilis offered an ‘unusual opportunity’ for observation. From its inception, the USPHS
regarded the Tuskegee Study as a classic ‘study in nature,’ rather than an experiment” (Brandt,
1978, p. 22).
The researchers had written no formal protocol for the study, but had the intent of
observing how syphilis affected the daily lives of men. Among those advocating for the study
was Surgeon General H.S. Cumming. Cumming’s advocacy came from the Oslo Study between
1890 and 1910. The Oslo Study, carried out by Professor C. Boeck at the Oslo Venereal Clinic,
intentionally withheld treatment to almost two thousand syphilitic patients. Cumming’s theory
was that the treatments available at the time would do more harm than good, therefore, Cumming
wanted to research the natural course of syphilis without treatment. According to results from the
Oslo Study, 70 percent of the patients went through life without inconvenience from the disease.
However, the remaining 30 percent experienced dramatic dangers of syphilis including
cardiovascular disease, insanity, and premature death (Brandt, 1978). After the Oslo Study, Dr.
J.E. Moore suggested that syphilis should not be allowed to pass untreated. The year that the
Tuskegee Study began, in 1932, Moore published a paper with six other syphilis experts that
strongly argued for the treatment of syphilis. Therefore, it is believed that the Oslo Study could
not have provided justification for the USPHS to perform a study that did not entail the treatment
of syphilis (Brandt, 1978). Concluding, “The doctors who devised and directed the Tuskegee
Study accepted the mainstream assumptions regarding blacks and venereal disease. The premise
that blacks, promiscuous and lustful, would not seek or continue treatment, shaped the study”
(Brandt, 1978, p. 23). Leaving room for the lack of treatment seemed natural to the USPHS
because many presumed the men would never seek treatment in the first place.
The Study Itself
Selecting Subjects
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The basic design of the study called for syphilitic African American individuals between
the ages of 25 and 60 years old. Every subject was to receive a full physical examination with xrays and a spinal tap to check for neuro-syphilis. “[The researchers] had no intention of
providing treatment for the infected men” (Brandt, 1978). When tasked with collecting subjects
for the study, the researchers found it more difficult than anticipated. Therefore, researchers were
forced to test large numbers of women and men who did not fit the original qualifications. When
the challenges in obtaining subjects for the study grew, Dr. Raymond Vonderlehr found that the
only way to obtain willing research subjects was to include the promise of free care. With this
offer, many became willing participants. “The USPHS did not tell the men that they were
participants in an experiment; on the contrary, the subjects believed they were being treated for
‘bad blood’ – the rural South’s colloquialism for syphilis” (Brandt, 1978, p. 24). To help
preserve the subject’s trust and interest, Vonderlehr provided the men with mercurial ointment,
knowing full well that it was a noneffective drug. After the USPHS approved continuing the
experiment in 1933, Vonderlehr decided it necessary to include a control group. The controls
were healthy, uninfected men.
Methods Used
In all, the study initially involved 600 African American individuals – 399 with syphilis
and 201 who did not have the disease (Centers for Disease Control and Prevention (CDC),
2011). The researchers based the experiment on deception. In a letter to the participants about a
spinal tap, it stated, “Remember, this is your last chance for special free treatment. Be sure to
meet with the nurse” (Brandt, 1978, p. 24). Brandt (1978) indicates further that the, “physicians
involved with the study believed that only autopsies could scientifically confirm the findings of
the study” (p. 24). To increase the deception, the USPHS hired Eunice Rivers, an African
American nurse, to give the men the noneffective medicine with spring tonic and aspirin, as well
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as follow the men’s health and secure approval for autopsies (Brandt, 1978). “More important,
Nurse Rivers provided continuity to the project over the entire forty-year period. By supplying
‘medicinals,” the USPHS was able to continue to deceive the participants, who believed that they
were receiving therapy from government doctors” (Brandt, 1978, p. 25). When subjects of the
study became severely ill, in order to persuade continued participation, the researches promised
to cover burial expenses.
During the 40 years of the study, the USPHS sought on several occasions to make sure
the subjects did not receive treatment from other sources. Vonderlehr went as far as meeting with
groups of African American doctors in Macon County to ask for the cooperation of not providing
treatment if study subjects asked for it.
The USPHS warned the Alabama Health Department not to treat the test subjects
when they took a mobile VD unit into Tuskegee in the early 1940s. In 1941, the
Army drafted several subjects and told them to begin antisyphilitic treatment
immediately. The USPHS supplied the draft board with a list of 256 names they
desired to have excluded from treatment, and the board complied. (Brandt, 1978,
p. 25-26).
Although Vonderlehr and the USPHS made efforts to ensure the men would not treated, by the
early 1950s, many of the men had secured some treatment without the researcher’s knowledge.
With the development of penicillin, about 30 percent of the test subjects had received this form
of treatment, but about seven and a half percent of those received adequate doses to treat syphilis
(Brandt, 1978).
The Results and Implications
The study continued well into the 1970s, with data and autopsies still being collected. Dr.
J. Lawton Smith stated, “You will never have another study like this; take advantage of it”
(Brandt, 1978, p. 26) when responding to the debate of whether to continue or end the study. On
August 28, 1972, the Department of Health, Education, and Welfare (HEW) formed the
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Tuskegee Syphilis Study Ad Hoc Advisory Panel in response to the criticism the press’
description of the experiment had created. This panel consisted of nine members, five of which
were African American. The focus of the panel was regarding two issues: 1) Was the study
justified in 1932 and had the subjects given informed consent? 2) Should penicillin have been
provided when it became available in the 1950s? (Brandt, 1978). The group issued the report in
June of 1973.
By focusing on the issues of penicillin therapy and informed consent, the Final
Report and the investigation betrayed a basic misunderstanding of the
experiment’s purposes and design. The HEW report implied that the failure to
provide penicillin constituted the study’s major ethical misjudgment; implicit was
the assumption that no adequate therapy existed prior to penicillin…Indeed there
is no evidence that the USPHS ever considered providing penicillin. (Brandt,
1978, p. 26-27).
The other focus of the report was on informed consent. Those on the panel declared the
experiment ethically unjustified due to failing to obtain the informed consent of the study
participants. “The Final Report’s statement, ‘Submitting voluntarily is not informed consent,’
indicated that the panel believed that the men had volunteered for the experiment” (Brandt, 1978,
p. 27). However, it is important to note that the National Archives’ records make it clear that the
men did not submit voluntarily. The men were told, and believed, that free treatment was being
provided by expert government doctors for a serious disease.
The Tuskegee Study reveals much about the beliefs within the medical community about
the nature of African Americans. The entire health community was jeopardized after the study
because of leaving a communicable disease untreated. “There can be little doubt that the
Tuskegee researchers regarded their subjects as less than human. As a result, the ethical canons
of experimenting on human subjects were completely disregarded” (Brandt, 1978, p. 27).
Through the course of the study, there was never any significant protest within the medical
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community. Additionally, the bureaucratic nature of the government did not seek reassessment of
the ethics and scientific value of the Tuskegee experiment. It was the press’ accounts in 1972
that finally created the realization that the study should be discontinued. Brandt (1978) says in
finalizing, “In retrospect the Tuskegee Study revealed more about the pathology of racism than it
did about the pathology of syphilis; more about the nature of scientific inquiry than the nature of
the disease process” (p. 27).
Finally, a class-action lawsuit was filed on behalf of the study participants and the
families of the participants in the summer of 1973. “In 1974, a $10 million out-of-court
settlement was reached. As part of the settlement, the U.S. government promised to give lifetime
medical benefits and burial services to all living participants” (CDC, 2011). The Tuskegee
Health Benefit Program (THBP) was set up to provide the medical services. In 1975, wives,
widows, and children were added to the program and in 1995, the program expanded to include
health and medical benefits. According to the CDC (2011), the last study participant passed in
January of 2004 and the last widow receiving benefits passed in 2009. Currently, there are 15
children who are receiving medical and health benefits.
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Chapter 3
Implications of the Tuskegee Study
Future Repercussions
Reduced Trust
The Tuskegee Syphilis Study has become known as one of the most abusive uses of
authority on the part of medical researchers. This abuse of authority has left many African
Americans skeptical about research participation. Deception, exploitation, and deprivation of
treatment in the Tuskegee Study were the root cause of the mistrust that was born from the study.
Within weeks of the first press reports of Tuskegee, African American press and leadership
began to synonymize the name Tuskegee with the work genocide (Fairchild & Bayer, 1999).
Examples of the Mistrust
In the mid-1980s, when the AIDS epidemic was becoming more highly recognized, New
York City proposed a way of interrupting the spread of the disease through a needle-exchange
program. “African American leadership gave voice to their dismay and fury, rooted in suspicions
that the failure to provide adequate treatment to drug users represented a form of genocidal
neglect” (Fairchild & Bayer, 1999). Political opposition to the needle exchange program came
from both law enforcement and the African American community. The 1988 needle exchange
program, which was developed by New York City’s health commissioner, was proposed as a
small experiment designed to determine whether the innovation could reduce the incidence of
HIV infection among users.
In denouncing the experiment, Benjamin Ward, the City’s African American
Police Commissioner, alluded to the Tuskegee syphilis trials when he explained
that his community felt ‘a particular sensitivity to doctors conducting
experiments, and they too frequently seem to be conducted against blacks.’”
(Fairchild & Bayer, 1999).
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However, by the mid-1990s, the African American opposition to needle exchange had almost
vanished because of the successful results that were becoming apparent.
Another example includes studies conductive by health departments, with support from
the CDC, to conduct studies of HIV infection in the population by testing blood samples,
removing all personal identifiers. Because the samples of blood had no personal identifiers,
ethical review boards deemed the study ethical without any problems. “However, anonymization
precluded notification of infected individuals” (Fairchild & Bayer, 1999). The criticism this
study faced was regarding the informing of individuals if tested positive for HIV, knowing that
treatment was available. CDC officials indicated the sole purpose of the study was to detect
populations most at risk of developing HIV, not for seeking diagnosis.
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Chapter 4
Current Ethical Guidelines for Research
Belmont Report
Basic Ethical Principles
The Belmont Report provides ethical principles and guidelines for protecting human
research subjects and was developed by the HEW. Many ethical guidelines are similar with the
four principles aforementioned. The first basic ethical guideline is respect for persons, in which
there are two separate moral requirements: “1) Individuals should be treated as autonomous
agents, and 2) Persons with diminished autonomy are entitled to protection” (University of Iowa
(UIowa), n.d.). Application of this principle means that subjects, to the degree capable, be given
an opportunity to choose what should or should not happen. Within the informed consent
process, there are three elements: 1) Information, 2) Comprehension, and 3) Voluntariness.
Information means the subject knows, “that the procedure is neither necessary for their care nor
perhaps fully understood, can decide whether they wish to participate in the furthering
knowledge” (UIowa, n.d.). Comprehension means that the information being conveyed by the
researcher is told in a manner and context that can be understood by the participant. However, it
may be necessary for the information being presented to be adapted to meet the intellectual needs
of the participant. Lastly, voluntariness is the agreement to participate voluntarily, free from
coercion and undue influence.
The second basic ethical guideline is beneficence. This guideline means that every person
involved with a research study is treated in an ethical manner by respecting the decisions of the
participants and protection from harm. Also, beneficence means making an effort to secure the
well-being of the participants. Two general rules have been formulated around beneficence: 1)
Do not harm, 2) Maximize possible benefits and minimize possible harms. When applying this
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guideline, it is important to determine whether the risks that will be presented to subjects are
justifiable risks. The elements of a risk and benefit assessment include the nature and scope of
the risks and benefits and the systematic assessment of risks and benefits. Assessment of
justifiability of research should reflect at least the following considerations:
Brutal or inhuman treatment of human subjects is never morally justified. Risks
should be reduced to those necessary to achieve the research objective. When
research involves significant risk of serious impairment, review committees
should be extraordinarily insistent on the justification of the risk. When
vulnerable populations are involved in research, the appropriateness of involving
them should itself be demonstrated. Relevant risks and benefits must be
thoroughly arrayed in documents and procedures used in the informed consent
process. (UIowa, n.d.).
Finally, justice means that there is a sense of fairness in distribution with research
precipitants. Selecting research subjects must be scrutinized to determine whether the subjects
are being systematically selected for reasons directly related to the study at hand. There are two
levels of justice relevant to the selection of study participants. First, social justice requires that
the can be a distinction drawn between the classes of subjects. It can thus be considered a matter
of social justice if there is an order of preference in the selection of classes, like adults before
children. Secondly, individual justice requires that the researchers exhibit fairness. “Thus, they
should not offer potentially beneficial research only to some patients who are in favor or select
only ‘undesirable’ persons for risky research” (UIowa, n.d.).
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Chapter 5
Summary
The premise for basic human rights, especially with research participants, has come from
many horrific and unethical practices in the late 1800s and through the middle of the 1900s.
Events like the Tuskegee Syphilis Study prompted the need for the development of guidelines
that researchers must abide by when conducting studies. The Tuskegee Syphilis Study not only
medically deprived African American males from needed treatment, but the researchers actively
and knowingly deceived the participants. Many would argue that this study’s implications had
much to do with racial pathology and little to do with medical pathology. Culturally, many white
individuals saw the African American population as evolutionarily lower than many other
humans. Therefore, the Tuskegee Study researchers entered the experiment with preconceived
notions about the African American population.
After a forty-year period, the American public awakened and realized the inhuman and
unethical practice of the Tuskegee Study. From this awakening arose a new standard of
guidelines for researchers and participants of a study known as the Belmont Report. Within this
report, one will find the proper ways of allowing autonomy, beneficence, and justice in a
research model. All three elements open the door for research participants to be treated fairly,
with little harm, and with full choice in continued participation.
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Chapter 6
Recommendations
After reviewing the details of the Tuskegee Syphilis Study, this author was shocked to
read about the injustice and unethical behaviors of medical professionals less than 40 years ago.
There are a number of areas that this author would change about the study. First, the mindset of
the researchers needed to change. This author believes that the overarching problem with the
study was how the African American individuals were perceived in the first place. However, this
author understands that changing cultural viewpoints is certainly not easy. Therefore, the next
change that this author would make in how the study was run would be to divide the subjects into
different stages syphilis. This author is skeptical that all subjects had the same stage of syphilis
as another, so determining the stage would create knowledge of when to begin treatment. That
leads this author to the next point in how the real treatment would need to be offered when it
became available. In this case when penicillin was shown to be a treatment, it would have needed
to be given immediately. Before penicillin was known to be a treatment, the researchers should
have made it known to the subjects that the treatments available did not show promising healing
aspects, instead showing more negative effects. Lastly, when World War II prompted the
drafting of soldiers, this author would allow those being drafted to receive the syphilis treatment
from the military. With men going to fight for the country, there is no reason why there would be
refusal for medical treatment.
Next, informed consent is a vital aspect of research and participation. Individual
autonomy requires that researchers respect the choices of the participants. Additionally,
researchers are responsible for ensuring the well-being of participants, also known as
beneficence. This author believes that the only scenario in which informed consent is not needed
is in the case of a life or death situation. For example, if an individual is involved in a serious
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auto accident and a medical professional seeks to save the individual, that medical professional
will not ask the individual if it is okay. Rather, that professional will perform the duties to save
the individual’s life. Even if there is harm done to the individual, but the life is saved, that is
ethically appropriate. However, in the case of an organized research study, this author does not
see any scenario that would dismiss informed consent. This author believes the research studies
of today are prized on the informed consent of the participants and should remain such.
Lastly, when raising the question about waiving informed consent for some areas of
clinical investigation, this author sees a couple problems surfacing. First, this author knows that
the legal system has quickly turned into an escape for individuals who feel have been unethically
treated. Even if an individual signs a piece of paper acknowledging waiving consent, there can
be negative repercussions if something goes wrong. Waiving consent could possibly lead to
taking advantage of vulnerable populations, but again, a vulnerable population is in the eyes of
the beholder. If a clinical investigation clearly waives consent and an unfortunate event takes
place during the investigation, the population being studied could then be seen as vulnerable. All
in all, however, this author does not see any waive of consent during clinical study and
investigation ethically acceptable. The Belmont Report and Nuremberg Code clearly give the
guidelines that must be followed. After reviewing the Nuremberg Code’s history, the Tuskegee
Syphilis Study, and the Oslo Study, this author believes there have been too many instances
where consent, beneficence, and justice have been overlooked and dismissed. Therefore, this
author believes that the research must oblige to the highest standard of treatment of research
participants.
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References
Brandt, A.M., (1978). Racism and research: The case of the Tuskegee Syphilis study. The
Hastings Center Report 8(6), 21-29.
Burke, R.E., & Friedman, L.H., (2011). Essentials of management and leadership in public
health (1st ed.). Sudbury, MA: Jones & Bartlett Learning.
Centers for Disease Control and Prevention. (2011). The Tuskegee timeline. Retrieved from:
www.cdc.gov/tuskegee/timeline.thm
Eleftheriadis, P., (2012). A right to health care. Journal of Law, Medicine, & Ethics, 268-285.
Fairchild, A.L. & Bayer, R., (1999). Uses and abuses of Tuskegee. Science 284(5416).
Nixon, S., & Forman, L., (2008). Exploring synergies between human rights and public health
ethics: A whole greater than the sum of its parts. BMC International Health and Human
Rights, 8, 1-9.
University of Iowa. (n.d.). A summary of the Belmont Report. Retrieved from:
http://hso.research.uiowa.edu/print/book/export/html/311