Ethics In The Healthcare Setting: Tuskegee Syphilis Study

Table of Contents

Ethical Principles

The Belmont Report and Nuremberg Code

Universal Declaration of Human Rights

In conclusion

Cites

Patients trust healthcare professionals. They have a huge responsibility to ensure that they receive the best care. The Tuskegee Tuskegee experiment in Alabama was a sad reminder of this responsibility. The study, which ran from 1932-1972, involved 400 African American men living with syphilis. The government misled the participants by telling them they needed treatment for syphilis. Participants were then offered incentives, such as free healthcare, to continue participating in the study. The study progressed and treatment was withheld, which caused the participants’ health to decline. Healthcare is only possible if ethics are practiced. Patients’ healthcare experience can be harmed if it lacks ethics. This study was not ethically sound and violated the Universal Declaration of Human Rights. The Tuskegee report is connected to the Belmont Report, which sought ethics improvements in healthcare.

Ethical PrinciplesThe Tuskegee men who participated in the syphilis research did not have respect for people, justice or beneficence. Respect for people and respect for dignity are related to a person’s freedom to make their own decisions and to be fully disclosed (Polit, 2018, pdf.175). This is how participants should be able to participate in studies without fear of being treated unfairly. You have the right of understanding what is happening and to question or halt engagement without being persuaded. Full disclosure promotes informed, fair and impartial research participation. Side effects are included and there is the option of quitting. It is forbidden to use coercion, bribery or blackmailing. This is because it interferes with free will and forces people into making decisions that are not in line with their true intentions. The procedures were not disclosed to the men, including important information such as a detailed briefing. They were informed that Syphilis treatment would be free for them if they agreed to participate. This is a form deceit because patients are enticed to participate by offering free healthcare and incentives. The patients were not treated for the syphilis at all in the end. They weren’t even informed about what the study was, its risks, or the procedures. A letter sent to them falsely stating that a spinal tap was necessary for Syphilis treatment was another example of disrespect. This was done to test more men. This is manipulative and shows a lack of respect for the patient’s integrity and right to be informed. The Deadly Deception, 2019, offers them $50 dollars worth of insurance in exchange for continuing to be involved with the study. This is another form o coercion in which patients were persuaded into participating in the Tuskegee research. One important point to keep in mind when looking at the Tuskegee studies was the lack beneficence. Beneficence means that you have the right to prevent any exploitation or harm. This act aims to minimize harm and maximize the benefits of healthcare. Researchers are required to not use patient information and conduct experiments that will benefit patients. A good example of beneficence not being applied was the refusal to give penicillin to Tuskegees men, which was recommended to treat Syphilis. Researchers were able to use the men’s lack of knowledge about how to fight syphilis, and exploit that knowledge to their advantage. Penicillin was also known to reduce the effects of syphilis. In many ways, the Tuskegee Study was an abandonment of justice. This principle guarantees fair treatment and privacy. The way the participants were informed that the study would be for 6 months was one example of injustice. It ended up taking 40 years. This time difference is also indicative of a lack in transparency. Researchers may be negligent or malicious when they investigate this matter. Another example of the injustice in the Tuskegee Tuskegee research was the targeting Tuskegee men for their vulnerability due to poverty. The study did not include syphilis sufferers of color, which is a discriminatory bias. This is important as it pertains to the education of participants and their willingness to protest the Tuskegee research. The Tuskegee research also violated privacy by sharing information with major medical journals as well as the U.S Congress over the entire 40-year period (The Deadly Deception, 2019). The Belmont Report and Nuremberg CodeThe Belmont Report was created in 1978 to promote ethics in healthcare. These ethical principles were developed by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (Polit 2018, pdf.171). Situations such as that of Tuskegee raised awareness about the dearth of ethics in healthcare. This may have helped to establish regulations such the Belmont Report. In response to Nazi physician atrocities, the Nuremberg Code of 1948 was another form of regulations. The Nuremberg Code has ten principles. The most important point was that all participants in experiments or studies must consent to being informed (The Nuremberg Code (2018)). The subject must be able to consent. It is essential that the subject is able to understand and give consent. Nuremberg trials were held as a trial to find Nazi doctors responsible for performing inhumane and unethical experimentation on captives in concentration camps (Science Museum). The Tuskegee Studies did not consider the Nuremberg codes. Penicillin was discovered to be effective in treating syphilis around the time the code came into effect. Scientists from Tuskegee dismissed the validity of the Nuremberg Code. They refused to give penicillin treatment to the men even though it was acknowledged as such, knowing that this neglect could lead to harming and possibly killing participants. Universal Declaration of Human Rights, established 1948. The Tuskegee studies’ unethical practices led to the violation of the UDHR. This declaration was established to provide a standard of ethics for all citizens. The Tuskegee violated Article 5 of UDHR (UN 2019,). Article 27 (UN 2019, 2019) also entitles scientists to protect their moral and material rights in scientific involvement. The Tuskegee Study did not ask or consider the participants’ moral needs. Eunice rivers was the nurse who monitored and cared for the Tuskegee subjects. She was responsible for gathering participants to annual roundups as the Tuskegee doctors arrived (The Deadly Deception), 2019. As a nurse, it is important to advocate for those you care about. She wasn’t advocating for men and their situations. Even though she did not have the latest approaches, she was educated enough to be a nurse to understand the risks and information associated with the study. Her role was also to restrict penicillin access for men. She should have challenged her actions, and scientists and other medical personnel. This situation requires nurses to act ethically. The Tuskegee era saw research practices that were more rigorously regulated than they are today. The standards for medical organizations were not established until the mid-20th century. The Belmont Report, Declaration of Human Rights and Nuremberg codes were the first to establish standards for healthcare organizations. Regulation has evolved and is more complicated to protect patients. Today’s innovations include the disclosure of rights and informed permission, which patients must give before they can participate in research. Participants are also required to keep their identities confidential, which makes it easier for patients to access their information. Communication with patients is improved. They are now able to express their concerns and address any stressors they may have regarding healthcare. This is a substantial improvement on the Tuskegee-era practices. Both periods have a common theme because there is still improvement to be made in terms of serving a diverse community. Without facing the past, today’s healthcare system would not include many safety and precautionary practices. The Tuskegee investigation proved that regulations were necessary given the severe responsibility of healthcare professionals. The Tuskegee Study proved that informed consent was necessary. Other rights, such as the right not to participate in a study, were also established. These regulations came from the UDHR Code, Nuremberg Code and Belmont Report. It is important to learn from past mistakes and not repeat the same neglectful patterns. In order to prevent similar situations from repeating, it is essential to have an open mind and adhere ethically to healthcare policies. Cites

A destination for documentary enthusiasts. (n.d.). The Deadly Deceit. Retrieved from https://documentaryaddict.com/films/the-deadly-deception.

Polit, D. F., & Beck, C. T. (2018). Appraising evidence for nursing practices (9th): Essentials of Nursing Research. Wolters Kluwer published the book in Philadelphia.

A museum dedicated to the study of science. Brought into Life: Exploring Medicine’s History (n.d.). Retrieved from http://broughttolife.sciencemuseum.org.uk/broughttolife/techniques/nurembergcode.

THE NUREMBERG COMDE. (2018). Retrieved from https://history.nih.gov/research/downloads/nuremberg.pdf.

The United Nations. (2019). The Universal Declaration of Human Rights is a document that outlines the rights of all humans and declares that everyone is entitled to certain fundamental freedoms. It asserts that all people are born free and equal in dignity and rights, and should be treated with respect and dignity regardless of race, gender, or any other status. It also states that everyone has the right to life, liberty, and security of person, as well as the right to seek and enjoy freedom of expression and opinion. Retrieved October 20, 2019, from https://www.un.org/en/universal-declaration-human-rights/index.html.