Question

2.What recommendations could you make to the researchers to safeguard the ethical standards for research in the Tuskegee Syphilis Study? Consider each of the following ethical issues: informed consent; confidentiality; privacy; physical or mental distress; sponsored research; honest disclosure of results; scientific advocacy; protecting vulnerable clients; and withholding treatment for research purposes. Do you think the study could be done ethically at all? Support your conclusion.

Answer 1

• Recommendations to researchers to safeguard the etical standrads for research in the Tuskegee Syphilis study upon considering the various ethical issues includes:

1. The first recommendation was information should be supplied to all participants about the actual research and the fact it was a study. The participants also should have been allowed to participate with full knowledge or limited knowledge, their choice. The study could have occurred with a control group receiving the drug when it was discovered, and only limited time for those not taking the drug.
2. Several major ethical issues involving human research subjects need to be studied further. The first major ethical issue to be considered is informed consent, which refers to telling potential research participants about all aspects of the research that might reasonably influence their decision to participate.
3. The second major ethical issue is the withholding of treatment for research purposes. This is the gravest charge against the study. Patient welfare was consistently overlooked, although there have been multiple attempts to justify why penicillin treatment was withheld. Some physicians felt that repair of existing damage would be minimal, and others felt that the damage that could result from reactions to the penicillin therapy, including fever, angina, and ruptured blood vessels, would outweigh its benefits. At the time of the Tuskegee Study, no data was available on the efficiency of penicillin treatment in late syphilis, and short- and long-term toxic effects of drugs had not been well documented. In short, when the study was evaluated periodically, researchers judged that the benefits of nontreatment outweighed the benefits of treatment. Moreover, the subjects were never given a choice about continuing in the study once penicillin had become available; in fact, they were prevented from getting treatment.
4. Second, accurate records were not kept. The number of subjects who died from syphilis was never known. The number of survivors was estimated to be between 76 and 111, and the number of dying was estimated between 28 and 101.
5. Third, beliefs within the medical profession about the nature of African Americans, sexual behavior, and disease clouded the study. As a result, the health of an entire community was jeopardized by leaving a communicable disease untreated.
6. Fourth, although no comprehensive report was ever published, the study was reported in medical journals for nearly 40 years without protest from anyone in the medical community. The investigating doctors never questioned the morality of the study. Also, the Department of Health, Education and Welfare (HEW) had no mechanism for periodic reassessment of the ethics and scientific values of the studies being conducted.

• The Tuskegee Study raised a host of ethical issues such as informed consent, racism, paternalism, unfair subject selection in research, maleficence, truth-telling and justice, among others. By the end of the study, only 74 of the test subjects were alive. Of the original 399 men, 28 had died of syphilis, 100 were dead of related complications, 40 of their wives had been infected, and 19 of their children were born with congenital syphilis. The study became unethical in the 1940s when penicillin became the recommended drug for treatment of syphilis and researchers did not offer it to the subjects. The study could be done ethically by considering the voilated rules and rights of the research subjects. Many human lives could be saved through proper controlled mechanism based study incorporating the ethical principles in study.