Term Paper on "Ethics and Morality the Medical Profession Today"

Term Paper 6 pages (1980 words) Sources: 3 Style: APA

[EXCERPT] . . . .

Ethics and Morality

The medical profession today is one of the establishments that ensures modern human longevity. When therefore needing medical services, the tendency is to trust doctors and nurses to do whatever is necessary to ensure the continuation or the return of optimal human health. In order to reach its current position, research is of extreme importance to develop the most effective drugs with the fewest side-effects in order to ensure optimal human health and longevity. Problems arise when the directive to conduct targeted research overrides ethical guidelines regarding disclosure and respect towards human research subjects. Often cited as the worst case of its nature in terms of patient rights and research ethics violations is the Tuskegee Syphilis Study, using human subjects without disclosing to them either information regarding the study or their status as infected with the disease.

The Tuskegee study began innocently enough, arising from the need to improve the health of southern African-Americans during 1928 (Tuskegee University, 2007). After a Public Health Service (PHS) study on black employees of the Delta Pine and Land Company of Mississippi, it was found that 25% of over 2000 tested employees had syphilis. It was then decided that the PHS and the Julius Rosenwald Fund, a Chicago-based charity that approached the PHS regarding the problem of African-American health, would collaborate in treating the Mississippi employees. Later, the program was expanded to include five more counties in the south. Funding for the treatment program however soon became problematic.

With the Great Depression during the 1930's however, financial problems arose for both the community and the medical profession. The Rosenwald Fund had to withdraw its support, leaving the PHS without resources to continue treating the ill. There was therefore extreme pressure for either funding or terminating the program altogether. Up to this point, no ethical boundaries have been crossed.

In addition to funding, another factor influencing the turn of events during the 1930s is the debate around the racial variations of syphilis. This led to a suggestion to study the effects of untreated syphilis on living study subjects. While controversial, this point still does not entail any violation of ethics, as the study was still at the discussion stage. Furthermore, with the correct ethical disclosures and fully informed subject consent, it is possible to conduct such a study in an ethical way. This however is not what occurred for the next four decades.

The Tuskegee Institute provided its help in identifying subjects in return or money, training and employment or the nurses it trained. A contributing element to the nature of the experiment is also the fact that, at the time, the level of access of African-Americans to medical care was negligible. The PHS exploited this by offering free health examinations, food and transportation, with burial stipends to family members in return for autopsies on deceased subjects. In terms of ethics, there is no fundamental violation of ethical principles in offering incentives for participation in medical studies. Indeed, incentives are still very much part of medical studies today.

The problem does arise with disclosure and consent. Study subjects were neither told that they had syphilis, nor were they treated for the disease. Indeed, even other agencies were prevented from providing treatment to the study participants. Not being informed of their condition, neither the participants nor their families were given the opportunity to consent to their treatment, or lack thereof.

Most notably, the participants did not receive treatment during World War II, where their draft boards ordered treatment for soldiers with syphilis. Nor did they receive treatment with those receiving penicillin for the condition during 1943. Furthermore, until the termination of the study during the 1970s, local health departments cooperated with the PHS in denying treatment to the study subjects.

Several repercussions followed the public disclosure of these violations. One of these is the inception of a formal Code of Ethics specifically for conducting medical research on human subjects. Tragically, however, the damage is irrevocably done. African-Americans for example display a general mistrust of public health institutions (Tuskegee University, 2007). Furthermore, in a study conducted by the Southern Christian Leadership Conference, it was found that 34% of a 1056 sample of African-American Church members believe that AIDS is an artificial virus, 35% believes that the disease is a form of genocide, and 44% believes that the government is not disclosing the full truth relating to the disease.

In the Tuskegee Study, no benefits to either medical professionals or society can be cited in support of the violations committed during the study. From any angle, it is a clear violation of human rights and a denial of human dignity. Patients used in this way need to be aware of all the dangers so that they can give informed consent to be used for the study. Patients did receive the benefits mentioned above, but these do not measure up to the level of deceit that was perpetrated. Furthermore, the mistrust among African-Americans works to the detriment of all current efforts to improve medical care for those with serious diseases such as AIDS. Proper healthcare can only occur in an environment of mutual trust between medical professional and patient. This element is largely missing from the African-American community, whose members are often in dire need of proper medical care. It could therefore be said that the Tuskegee study was conducted on the basis of blatant racial discrimination. Any beneficial outcomes of the study have long been negated by its negative consequences for the African-American community today.

Clear guidelines and ethics committees, as well as institutional compliance structures are essential when using human subjects for medical investigations. These structures need to be impartial in their judgment and enforcement of compliance with existing ethical rules. The World Medical Associates (2004) has for example created a policy relating to human subjects in medical testing. Among others, the principles include human health as primary consideration. This includes both the community and the subjects of the research. Another important principle is that this health consideration should include the precedence of this consideration over the interest of medical and scientific community. The basic principle of all medical research involving human subjects is respect for the subject. Such respect would then dictate optimizing the health of the subject while obtaining consent for all stages of testing and for all the risks involved. In assessing the risks of the testing, these should be weighed against the benefits for both the subject and the medical community. Hence, denying treatment for subjects who are known to be ill and who can be cured as in the Tuskegee case is a violation of almost every research principle in existence.

Those in management positions at institutions such as the PHS and the Tuskegee Institute should collaborate with ethics committees in order to ensure that all ethical principles are in place when conducting a study involving human subjects. The committees are also to ensure that the benefits of the experiments are likely to outweigh the costs. Certainly the Tuskegee Study's costs far outweighed its benefits for the participants involved and eventually also for the medical practitioners conducting the study in terms of settlement compensation.

If I were in a management position at the time, I would probably have conducted thorough inquiries into the nature of the experiment, as well as the ethics procedures involved. I would have consulted experts in the field of medical research rather than let the financial and other benefits of the project cloud my better judgment. I would also not trust my judgment alone, but assemble a committee of persons both from within my institution and from the community in order to determine what the correct course of action would be. After committee meetings to determine the recommendations of all members, I would take the matter into consideration and make an informed decision. Doubtlessly my decision would have been not to allow the testing unless all patients were kept informed regarding their status and treatment choices. I would not have allowed a test where participants were refused treatment indefinitely. Possibly I would not have allowed the test at all, because the benefits to both patients and society were based on mere hypothesis on the one hand, and were very minimal on the other.

It is the responsibility of management to ensure that all possible liabilities to the company are covered. Where human rights are being violated in as blatant a manner as described in the Tuskegee study, there is a very clear liability issue, even if this was only decades after the start of the study. The main principle of respect for human subjects should always be the center of concern when such studies are involved. Management, along with ethics committees, are to ensure that this principle retains central stage above and beyond either financial or personal considerations.

In modern times, it is almost unthinkable that anything like the Tuskegee Study could happen again. However, according to Philip J. Hilts (2000), even the new millennium… READ MORE

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