HALLEBERRY G.

NIETES BSN 2-B CTA#5 THE APPLICATION OF BIOETHICAL PRINCIPLES

The Deception Within the Tuskegee Syphilis Experiment

According to Friedrich Nietzsche, “absolute power corrupts absolutely”, and the Tuskegee
Syphilis Experiment is the demonstration of science weaponized against humanity at the hands of
corrupted power that should be a call for further attention to the biases of the human mind and to
the ethics in healthcare and medicine.
The Tuskegee Syphilis experiment refers to the study conducted at the Macon County in
Tuskegee, Alabama in the United States of America. This was considered the longest non-therapeutic
experiment that lasted for 40 years (ended in 1972) wherein African American participants in that area
were studied to understand the effects of untreated syphilis. This study was brought to and accepted
by the communities involved under the guise that it was the continuation of the “Rosenwald Fund
Syphilis Control Demonstration” and were expecting to receive treatment.
Although branding itself as a study on untreated syphilis, James Jones (Professor of History at
the University of Arkansas and author of Bad Blood: the Tuskegee syphilis experiment) details how the
individuals were instead undertreated and mentions the confession of Nurse River, a black nurse later
involved with the experiment, who alongside gave aspirin and iron tonic to keep the image that the
affected individuals were feeling better as they undertreated them. A complex mix of the US political
system which involved the promotion of those already in positions of power that led to no new eyes
on the ethics of the experiment, and the subsequent decisions made to continue withholding proper
treatment based on racist assumptions resulted in the unethical study to last for decades. The
revelation of the facts of the case led to public outrage and a deep breach of trust in the medical
institutions that persists long after the whistle was blown on the experiment.
It's easy to fall into the trap of believing that an ethical dilemma can easily be identified and
resolved, especially without the nuances of the case. The biases or tricks of the human mind is one
factor in particular that stands out strongly to me in this case. There was a belief in the medical system
during that time that syphilis in African Americans was a different type of disease from that which
affected the white people. This was on the observation that African Americans do more physical labor
and a reductionistic inference that this is the reason the disease attacks the cardiovascular system in
these groups of people. They assumed the disease attacks the neural system of white Americans due
to their bigger and frequent use of their brains. African Americans were seen as a syphilis-soaked race
whose animalistic sexual appetite is innate thus the indifference towards treating the disease.
However, it was found out (and mentioned by J.H. Jones) that of the 32% that tested positive in syphilis
in Tuskegee, Alabama, 62% were cases congenital in nature rather than venereal. This biased
assumption was evidence of prejudice and racism within medicine.
It's illogical to assume correlation is the same as causation; it was a form of affected ignorance
to refuse to take action and to deny the truth that these were individuals who deserved treatment or
the pursuit of it. It violates the bioethical principle of justice—despite the prejudicial beliefs about the
nature of the disease, the opportunity at receiving treatment should be impartial to race, sex, or
gender. One may argue that those most in need of treatment should be of more priority and that there
is a discriminatory element to the distribution of resources when they are finite, like more focus (but
not limited to) on women for breast cancer due to a higher incidence in the sex, but it was the
unfounded basis for the non-prioritization to treat the African Americans that demonstrates the lack
of justice. Affected ignorance decreases the voluntariness of the act but increases the accountability
because it was maliciously kept.
Although the experiment aimed to highlight the deadly nature of the disease in African
Americans by studying the effects of untreated syphilis, it was a pursuit of treatment that gave no
justice to the affected individuals and violated respect for autonomy. The principle of double effect
does not even apply in this case—where it is permissible to cause a side effect harm to bring about a
good result even if it’s not permissible to cause the said harm as a means. Letting things play out even
on the basis that the individual would’ve suffered their natural fate in order to benefit society
demonstrates using harm as a means to an end. Again, the affected ignorance towards the actual
nature of the disease being deadly plays out (they assumed it was innate and not as deadly to African
Americans). Harm from withholding treatment was not a side effect but a means to an end. There
were hints of awareness of the unethical premise as they deliberately hid the fact that they were not
giving any treatment from the community (who made efforts to check) and propped up the image
that treatment was provided. The affected individuals were not patients but participants of a study
they would otherwise have chosen to refuse. There were no compensations for them nor the informed
consent of the active withholding of treatment. Non-disclosure of the details of the experiment to the
community and the active lying undermines the principle of respect for autonomy.
It stops being ignorance after learning that the study continued to persist long after the civil
rights movement promoting the rights of black Americans, the discovery of penicillin, or the
Nuremberg Trials and the Nuremberg Code being established occurred. All were instances where a
decision was made to continue not treating the individuals. Initially, the experiment was to end after
8 months, however, because of the promotion of the those who were previously involved in
conducting it (Raymond Vonderlehr-previously part of the team that conducted the experiment was
promoted to Director of Venereal Disease in the US), the study was continued. An assessment was
done on the ethical nature of the experiment, but the committee that assessed the case were still
composed of those involved (and no African American representative). The push towards science
being the justification and that it was owed to those who’ve already died to wait for the last participant
to die just shows the mind games people play to avoid facing the morality of their actions and the
great consequences it comes with. It violates the principle of non-maleficence since the act of
withholding treatment is a form of inaction that causes harm. I view the inaction as still being a form
action that deliberately induced harm and death. There was also a violation of beneficence as they
knowingly prevented the promotion of good had they chosen to provide treatment.
Willie Johnson, Bryan Hodman, and "Big" Ben Washington, were the men in the movie “Miss
Evers’ Boys” are just a few of those who were a victim of this unethical and immoral experiment. These
individuals deserved justice and the right to fair access to proper treatment. They deserved respect to
autonomy by acquiring full knowledge of the nature of the treatment they were undergoing, what
they were consenting to participate in, and the right to refuse. They also did not deserve the knowing
infliction of harm which goes against the principle of non-maleficence but deserved to receive the
appropriate treatment (beneficence). I went looking for supplemental information on the case and it
was the structure and how the experiment unfolded that fascinated me more than the movie. It
showed just how corrupt a system can get and the extent and the details on the case that reveal itself
when you explore the individuals involved in the continuation of the study.
There is no angle to this case that seems to justify the trail of death and suffering that it left
in its wake. There is no compensation that will satisfy as an apology nor immediately repair a deep
breach in trust in the healthcare or medical systems. The experiment is a display of the flaws of the
human mind—the viewing of some individuals as less than human and expendable is a difficult and
complex issue of its own. Until we have yet to fully grasp how our mind works, cases like the Tuskegee
syphilis experiment serve as a reminder of why patients have rights and codes of conduct like the
Nuremberg code exist. Not only is there death with corrupt medical systems, but a breach in trust
ruins the institutions reputation to the individuals that need help, and their refusal to seek treatment
is also yet another form of death sentence.