Katera Sales

Biomedical Ethics Final Paper

The Tuskegee Syphilis Studies: A Discussion on Ethics

In 1932, while the Great Depression ravaged the economy, one pivotal study damaged
what was considered medical ethics in American medicine at the time. The Tuskegee study
revolved around syphilis a sexually transmitted disease that, if left untreated, can cause serious
complications. It also can hide behind many symptoms that can be indicative of other diseases.
The infection starts out as a painless sore, and it grows to rashes around the body, and affects the
internal organs in its latest stage. However, before a cure was invented, syphilis could cause
death, and indeed it did, especially to the patients of the study (CDC.gov).

The study took place in Macon County, Alabama, right next to the Tuskegee Institute
this place was chosen because it had one of the highest rates of syphilis in the nation. The men
were courted by offers of free medical examinations. The study itself was done mostly to study
the effects in syphilis in African Americans it was widely believed (yet never proven) that the
disease affected different races differently. For African Americans, it was believed that it affected
their cardiovascular system rather than their nervous system. Also, treatments were available, but
were believed to exacerbate the symptoms rather than alleviate them (Murphy).

It was also said that the men were tricked into thinking they had bad blood, which at
the time was a term used to describe any sort of fatigue, or anemia. It also referred to syphilis at
times. Unfortunately, the men never actually received the treatment they needed for their illness,
and some of the men who did not have the disease contracted it during the study. In exchange for
their participation in the study, they were given free rides to the examinations, free medical
checkups, meals, and burial insurance. In addition to the already questionable ethics, the study
only was intended to last 6 months. Instead, the study dragged on nearly 40 years (CDC.gov).

So how exactly was the study discovered? It could be safely assumed that many of the
men involved had no clue that the study was unethical. Many of them who had the disease
probably didnt know, and the ones who contracted the disease may not have known that they
contracted it. Also, the incentives were convincing, so the families of the patients were probably
unaware that their fathers, brothers, uncles, sons, and nephews were being treated unfairly. The
issues began when a tested cure for syphilis was released in the late 1940s, and it was widely
available. The cure was never offered to the men in the study. The names of the men were only
circulated between the physicians who took part in the study preventing them from getting
treatment (CDC.gov). From there, criticisms started to arise as early as 1968 starting with Peter
Buxtun, a U.S. Public Health Service employee who blew the first whistle on the studies
(Government Accountability Project). Then, in 1972, an Associated Press story was written
highlighting the ethical flaws of the study. The study ended in 1972, with a class action lawsuit
being filed and the families of the men in the study, including any survivors at the time, received
$10 million as well as lifetime health benefits and insurance (CDC.gov).

How, then, is this study framed in the view of ethics? From the doctors perspective, it
could be just a desire for more scientific knowledge. Considering the time in which the study
was done, race may have played a factor in how the study was conducted, but the study, at least
on the surface, was most likely done simply for research purposes, and the ethics of the study
may have taken a backseat to the information about the disease. However, what makes the study
even more ethically inept is that the patients concept of ethics and morality, especially those with
the disease who may not have known they had it, makes this study a shining example of
asymmetric information. The doctors simply knew more about the health of the patients than the
patients did. As such, they kept the patients from knowing critical information about their health,
the disease they were being studied for, and the cure to the disease that had never been
administrated to them.

The notions of health and wellness among the two parties is also extremely different. The
patients, as evidenced by their calling diseases like syphilis, fatigue, and anemia bad blood,
may see health and wellness through a tunnel if they can function properly and do exactly what
they need to do, they see themselves as healthy. Thus, things like chronic aches and pains that
may be indicative of more serious conditions go unnoticed. Conversely, the doctors clearly have
a much more complete sense of what health means and how to attain it.
 So, what objections, if any, are valid to ensure that problems such as the ones presented
in this example dont exist again? Taking a look at James Rachels words on bioethics and ethical
theory, we can see that the patients view of health is synonymous with the physics/car mechanic
model where a car clearly operates on the laws of physics, but the person that fixes it does not
have to know physics. Likewise, it does not take extensive knowledge of biology to take care of
oneself or to stay healthy. Unfortunately, that lack of biological knowledge impairs the patients
ability to truly know how healthy they may or not be, and it also makes them unable to discern a
good medical diagnosis from a bad one. This case of asymmetric information leads into another
important problem, from which the principal-agent problem arises telling patients the truth
(Rachels).

In 1959, a patient named Christiane Volling was born with a unique (yet not uncommon)
condition she was born with what medical professionals call ambiguous genitalia. In
laymans terms, if a child is born with genitals that are not fully male or female, an emergency
surgery is done to determine the childs sex. In Vollings case, she was never told the results and
was raised male, but during a surgery at the age of 14, she was found to have a full set of female
reproductive organs. The female organs were removed, but Volling later transitioned to become a
woman, and sued in 2006 for not being informed of her status. This raised serious ethical
questions. One: even if medical knowledge is highly specialized is it okay to withhold
information from unsuspecting patients, even if they may not understand it? And is it okay to not
tell patients news despite them possibly not wanting to hear it? Per Roger Higgs, the answer to
both questions is no in no case is it acceptable to withhold the truth from patients, no matter
how complex or depressing the information.

With this knowledge, going forward, as new medical phenomenon are discovered and
people are becoming more educated about health, there are still concepts that laymen in the
medical field will not be able to understand. Therefore, it is the responsibility of medical
professions to hold high moral standards and never place convenience or pure scientific curiosity
to cost people their lives doing anything less places our whole society at risk, starting with
even the smallest breach of ethical theory.
 Works Cited

1. Syphilis - CDC Fact Sheet. (2016). Retrieved December 01, 2016, from
http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm

2. The Tuskegee Studies. (2016). Retrieved December 01, 2016, from

http://www.cdc.gov/tuskegee/timeline.htm

3. Carr, D., & Rivero, M. (n.d.). Whistleblower Peter Buxtun and the Tuskegee Syphilis
Study. Retrieved December 01, 2016, from
https://www.whistleblower.org/blog/04302014-whistleblower-peter-buxtun-and-tuskegee-
syphilis-study

4. Higgs, R. On telling patients the truth. Retrieved November 30, 2016 from
http://philpapers.org/rec/HIGOTP

5. Rachels, J., Ethical Theory and Bioethics. Retrieved November 30, 2016 from
http://onlinelibrary.wiley.com/doi/10.1002/9781444307818.ch2/summary.