Syphilis was a widespread but poorly-understood disease until shortly after the turn of the century. Two of the principal steps forward were the isolation of the bacterium associated with syphilis in 1905, and shortly thereafter, the development of the Wasserman reaction to detect the presence of syphilis through a blood test. Still, much about the disease and its progress remained unknown. Due to this lack of understanding, many cases were incorrectly diagnosed as syphilis, while in other cases patients who would now be recognized as victims of the disease were missed. As the etiology of the disease was better understood, it became increasingly urgent to understand its long-term effects. The early treatments that predated the discovery of penicillin involving the use of such poisons as arsenic and mercury were dangerous, and sometimes even fatal. Thus, it was vital to learn about the likelihood that the disease itself would result in serious physical or mental disability in order to make sure that the potential benefits of treatment exceeded the risks. One long-term study had been carried out in Oslo, Norway. This had been a retrospective study, going over the past case histories of syphilis victims then undergoing treatment, and had been undertaken on an exclusively white population. In the early 1930s, the U.S. Public Health Service (PHS) began a program aimed at controlling venereal disease in the rural South. The Julius Rosenwald Fund – a philanthropic organization that was interested in promoting the welfare of African-Americans, provided the funds for a two-year demonstration study in Macon County, Alabama where 82% of the residents were African-Americans, most of whom lived in poverty and had never seen a doctor. A principal aim of this study was to determine the incidence of the disease in the local population while training both white and African-American physicians and nurses in its treatment. When the results revealed that 36% of the Macon County African-Americans had syphilis, which was far higher than the national rate, the Rosenwald Fund, concerned about the racial implications of this finding, refused requests to support a follow-up project. The discovery of the fact that the incidence of the disease was higher among African-Americans than among whites was attributed by some to social and economic factors, but by others to a possible difference in susceptibility between whites and non-whites. Indeed one Public Health Service consultant, Dr. Joseph E. Moore of Johns Hopkins University School of medicine proposed that Syphilis in the Negro is in many respects a different disease from syphilis in whites. In 1932 the PHS decided to proceed with a follow-up study in Macon County. Unlike the project supported by the Rosenwald Fund, the specific goal of the new study was to examine the progression of untreated syphilis in African-Americans. Permission was obtained for the use of the excellent medical facilities at the teaching hospital of the Tuskegee Institute and human subjects were recruited by spreading the word among Black people in the county that volunteers would be given free tests for bad blood, a term used locally to refer to a wide variety of ailments. Thus began what evolved into “The Tuskegee Study of Untreated Syphilis in the Negro Male,” a project that would continue for forty years. The subject group was composed of 616 African-American men, 412 of whom had been diagnosed as having syphilis, and 204 controls. The participants were never explained the true nature of the study. Not only were the syphilitics among them not treated for the disease — a key aspect of the study design that was retained even after 1943 when penicillin became available as a safe, highly effective cure — but those few who recognized their condition and attempted to seek help from PHS syphilis treatment clinics were prevented from doing so. Eunice Rivers, an African-American PHS nurse assigned to monitor the study, soon became a highly trusted authority figure within the subject community. She was largely responsible for assuring the cooperation of the participants throughout the duration of the study. She was aware of the goals and requirements of the study, including the failure to fully inform the participants of their condition and to deny treatment for syphilis. It was her firm conviction that the men in the study were better off because they received superior medical care for ailments other than syphilis than the vast majority of African-Americans in Macon County. The nature of the Study was certainly not withheld from the nation’s medical community. Many venereal disease experts were specifically contacted for advice and opinions. Most of them expressed support for the project. In 1965, 33 years after the Study’s initiation, Dr. Irwin Schatz became the first medical professional to formally object to the Study on moral grounds. The PHS simply ignored his complaint. The following year, Peter Buxtin, a venereal disease investigator for the PHS began a prolonged questioning of the morality of the Study. A panel of prominent physicians was convened by the PHS in 1969 to review the Tuskegee study. The panel included neither African-Americans nor medical ethicists. Ignoring the fact that it clearly violated the human experimentation guidelines adopted by the PHS in 1966, the panel’s recommendation that the Study continue without significant modification was accepted.
Directions: construct a short essay (3 pages) in which you support or oppose, on ethical grounds, the 1969 PHS decision. Be sure to evaluate the decision from more than one ethical position.
some ethical positions:
1 Kant’s Categorical Imperative
2 Hume’s virtue and vice theory
5 Ethics of Care
7 Ethical Egoism
8 Majority rules
Scenario Evaluation Rubric
Describes in detail two or more positions – Outstanding
Identifies and describes two or more positions – Satisfactory
Only identifies two (or fewer) positions – Unsatisfactory
Detailed recognition of both individual and societal impacts – Outstanding
Recognizes both individual and society impacts – Satisfactory
Does not recognize individual and societal impacts – Unsatisfactory
Contrasts the consequences of each enunciated position in detail – Outstanding
Contrasts the consequences of each enunciated position – Satisfactory
Does not contrast the consequences of each position – Unsatisfactory
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