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Medical Experimentation
http://www.bsos.umd.edu/
The United States has a long history of
human medical experimentation. As early as 1900, an American
doctor conducting research in the Philippines was found guilty
of infecting prisoners with the Plague and Beriberi.1 Such
incidents have outraged and shocked many Americans, but they
have continued to occur nevertheless. There have been some
interesting developments in human medical experimentation this
century, most of them referring to the idea of informed consent,
which has its roots in the Nuremberg Code.
In response to the atrocities Nazi doctors
and medical scientists had committed on prisoners in
concentration camps, a series of international and national
statutes were implemented to prevent further inhuman
experiments. The most renowned statute created was the Nuremberg
Code, established by a three-judge panel of U. S. judges, who
tried and convicted the Nazi doctors and scientists who had
subjected Jewish prisoners to cruel, inhuman, and nonconsensual
experiments. Developed as a legal guideline of what was
acceptable in international research standards, the Nuremberg
Code sought to govern medical studies performed on human beings
by providing ethical regulations for human experimentation based
on informed consent.
Despite regulations providing protection
for the welfare of human subjects, inhuman atrocities affecting
disadvantaged groups persisted in the United States. For
example, the U.S. government still managed to conduct studies
like the infamous Tuskegee Experiment, subjecting hundreds of
lower-class African-American men to syphilis so that researchers
could study and chart the natural progression of the disease.
After being the main advocates and initiators of codes to
prevent cruel experiments from being performed on human
subjects, the government still exposed disadvantaged groups to
inhuman research and experiments without getting their informed
consent.
After Allied forces defeated the Nazis and
other Axis powers, the Charter of the International Military
Tribunal was drawn up and Control Council Law No. 10 was
established as a uniform legal basis in Germany for the
prosecution of war criminals. Control Council Law No. 10 was
signed on December 20, 1945 and established the articles for the
punishment of persons guilty of war crimes, crimes against
peace, and crimes against humanity. Executive Order 9547, signed
by President Harry S. Truman, provided for the representation of
the United States in preparing and prosecuting charges of
atrocities and war crimes against the leaders of the Axis powers
and their agents and accessories 2. Afterwards, the military
government in the U.S. zone of Germany began setting out the
organization and powers of certain military tribunals. The
infamous Nuremberg trial was one such tribunal. It was
designated officially as the United States of America v. Karl
Brandt and Case No. 1 of Military Tribunal I. Military Tribunal
I was constituted on October 25, 1946, and immediately dove into
the prosecution of 23 German physicians and scientists
associated with the Nazi party who were accused of inflicting a
range of vile and lethal procedures on vulnerable populations
and inmates of concentration camps between 1933-1945.3
The Medical Case began a few months after
19 of 24 leaders of the Third Reich were found guilty of
accusations of war crimes.4 Twelve of the nineteen leaders were
sentenced to death, and the others were imprisoned for variable
terms. At first, American military forces occupying Germany had
not planned to conduct an inquest on human experimentation, but
they changed their minds as information emerged about the
medical atrocities committed in concentration camps. Shocked by
the information that they received, American forces decided to
pursue the matter as a war crime under the Charter of the
International Tribunal.5
On December 9, 1946, the twenty-three
physicians and scientists were put on trial for participating in
Adolph Hitler's racial cleansing movement. In his opening
statement, the chief prosecutor Telford Taylor claimed that the
medical practitioners were on trial for murders, tortures, and
other atrocities committed in the name of medical science.6 Many
doctors were involved in the Nazis racial hygiene policies, and
half of the German doctors were Nazi Party members. Those
medical physicians and scientists who were not members of the
Nazi Party had to be well connected with the Nazi political
hierarchy. Nazis believed that doctors had a special role in
improving the German race; after all, the medical and science
profession played a key role in developing and testing Nazi
racial hygiene theories.
At the end of the 19th century, German
Social Darwinists, fearing a general degeneration of the human
race, set about to establish a racial hygiene that would combat
the disproportionate breeding of inferiors, the celibacy of the
upper classes, and the threat posed by feminists to the
reproductive performance of the family.7 Anti-Semitism did not
play a major role in early racial hygiene theories as it did
when the Nazi Party started to rise. The masterminds of the
theory, Alfred Ploetz and Wilhelm Schallmayer, were more
concerned about the indiscriminate use of birth control by "the
fit" and the provision of inexpensive medical care to "the
unfit", than the breeding of superior races with inferior races.
In fact, Ploetz classified Jews, along with Nordics, as being
one of the superior, cultured races of the world.8 But that
attitude toward Jews had begun to change toward the 1920s and
the rise of Nazism. In 1918, racial hygiene was identified as a
political program that stands above all parties by the racial
hygienist Herman W. Siemens. Siemens argued that racial hygiene
was based on the facts of inheritance and variability.
"Inheritance" meant that man owed the essential part of his
character, good or bad, physical or spiritual, to his genetic
material, and "variability" implied that men differed
substantially in their genetic value resulting in men who were
genetically classified as fit or unfit.9 He claimed that if men
who were fit bred less than those who were inferior, the quality
of the race would decline. Siemens argued that the goal of a
positive racial hygiene was to ensure that the fit left more
offspring than the unfit, and if this failed, Germany would
collapse in the face of an Asiatic triumph.10
This philosophy evolved more in the
mid-1920s as the Nazi Party came to power and included in its
tactics anti- Semitism, especially when the right-wing faction
of the racial hygiene movement merged with National Socialism.
The conservative, anti-Semitic J.F. Lehmann Verlag took over the
publication of the main racial hygiene journal
shortly after World War I and set the stage
for Nazi ideologues to incorporate eugenic rhetoric into their
propaganda.11 Biology played an important role in Nazi ideology.
In 1929, a number of physicians joined the National Socialist
Physicians League to coordinate Nazi medical policy and purify
the German medical community of Jews. By 1933, nearly 3,000
doctors joined the League before Hitler came to power, and by
1942, more than 38,000 doctors (constituting about half the
doctors in the country) had joined the Nazi Party.12 In fact,
two major institutes were established, the Kaiser Wilhelm
Institute for Anthropology in Berlin and the Kaiser Wilhelm
Institute for Genealogy in Munich which recognized racial
hygiene as a primary research goal. Both institutes conducted
research in the fields of criminal biology, genetic pathology,
and human genetics. Both institutes also trained SS physicians
and helped construct the genetic registries later used to round
up Jews and Gypsies.13 These institutes along with other racial
hygiene institutes were also conducting twin studies, studies of
identical twins raised apart to sort out the relative influences
of nature and nurture in human character and institutions.
Racial hygienists believed that many human behaviors, such as
crime, alcoholism, wanderlust, and divorce, were at root
genetic, and studies of how twins behaved in different
environments were supposed to prove the ultimate genetic origins
of racial and social differences.14 Thus, the medical profession
was essential in the Nazi platform.
The Nazis adopted three main policies to
begin their medical racial cleansing programs. These policies
were the Sterilization Law, the Nuremberg Laws, and the
euthanasia operation, which led to subsequent mass killings.
Drawn up by several of Germany's leading racial hygienists, on
July 14, 1933, the Nazi government passed the Sterilization Law
permitting the forcible sterilization of anyone suffering from
genetically determined illnesses including schizophrenia,
epilepsy, Huntington's Chorea, deafness, and severe
alcoholism.15 As a result of the law, about 350,000 to 400,000
people were sterilized in Germany. Sterilization and abortion
were instituted for individuals of inferior genetic stock and
declared illegal and punishable in some cases by death as a
crime against the German body for healthy German women. Birth
control of all forms was prohibited, except for Jews in which it
was generally available and encouraged. Two years later, in
1935, Hitler ratified the Nuremberg Laws, excluding Jews from
citizenship and outlawing marriage or sexual relations between
Jews and non-Jews. A further measure, the Marital Health Laws,
required couples to submit to a medical examination before
marriage to detect and avoid the possibility of racial
pollution. The laws were considered public health measures and
were administered primarily by physicians.16 A month after World
War II began, in October 1939, the Nazis engaged in euthanasia
operations. Hitler decreed orders that certain doctors be
commissioned to grant a mercy death to patients judged incurably
sick by medical examination. The euthanasia operation was
planned and administered by leading figures in the German
medical community. The Germans forcible euthanasia operation was
an economic endeavor important during wartime to free up beds.
The first gassings of mental patients took place in Poland 45
days after Germany invaded that country. By August 1941, in the
first stage of the operation, more than 70,000 patients from
German mental hospitals had been killed. Afterwards, euthanasia
became part of normal hospital routine inGermany itself.
Handicapped infants, people requiring long-term psychiatric care
and judged incurable, and elderly patients in homes were
regularly put to death.17 To the Germans, these were people
whose lives were not worthliving. The euthanasia operation
eventually led to the destruction and genocide of Jews,
homosexuals, Communists,Gypsies, Slavs and prisoners of war.
The question of what to do with Jews was
cast as a public health problem to the Third Reich. In 1935, the
Fuhrerof the Nationalist Socialist Physicians League, Gerhard
Wagner, declared that Judaism was an incarnate disease.He
claimed that various diseases, including insanity,
feeblemindedness, hysteria, neuralgia, chronic rheumatism,
andflat feet were more common among Jews than non-Jews18 So
began one of the greatest atrocities of mankindwhen Nazis
enforced extermination of Jews and other populations by gassing
them in concentration camps. TheNazis used physicians and
scientists to carry out their sadistic policies and exploited
both the intimacy and authorityof traditional physician-patient
relationship. Doctors served as executors and performed
selections of people to bekilled in the concentration camps. In
fact, a decree was issued in 1943 saying that only physicians
trained inanthropology could perform selections at concentration
camps. 19
Medical professionals also used the Nazi
Party for their advantage and benefit. Ambitious researchers
used theracial hygiene policies to their advantage. The
researchers, many of whom were members of the Nazi Party,
couldavail themselves on experimental subjects without
limitations and could justify and rationalize their actions by
thenotion that the concentration camp inmates were eventually
slated to die.20 The medical community also grew substantially
under the Nazis, and the physicians achieved a higher status in
the period of Nazism than at any time before or afterwards. The
Office of the President at German universities was occupied by
physicians 59% of the time during the 12 years of Nazism in
contrast to 36% of the time for the decade prior to Nazism and
to 18% of the time for the decade following the Nazi period.
Doctors also prospered financially, earning 2,000 RM more than
lawyers by 1936. Also, many physicians were in support of Nazi
ideology and engaged in the correlation between Nazi ideology,
social policies, and medicine. They were intrigued by the Nazis
efforts to biologize or medicalize a broad range of social
problems, such as crime, homosexuality, the collapse of the
German imperial strength, and the Jewish and the Gypsy
problems.21 The physicians and the scientists wanted to be among
the first to make the medical break through that would advance
the military goals of the Third Reich and make them heroes of
racial medicine. The Nazis, the physicians, and the scientists
all held this view:
There were superior and inferior races,
worthies and unworthies, healthy and diseased. If it required
the deaths of 20 or 100 Russian prisoners of war to increase the
chances of saving one German pilot, this was a justified
investment. Concentration camp inmates were valued as slave
labor and when that labor was exhausted, they were not even
worth keeping alive. They were lives without value, and their
death implied a saving. The urgency of the war effort and the
endorsement of the highest state authorities further encouraged
physicians and scientists to perform human subject research on
problems of pressing concern on the battlefield.23
During the trial of the 23 physicians and
scientists, the racial hygiene view was used to justify their
participation in the vile human experimentation they conducted
with concentration camp prisoners. The physicians maintained
that research was necessary in times of war and national
emergency, military and civilian survival was dependent on the
scientific and medical knowledge derived from human medical
experimentation.24 The trial was held at Hitler's Palace of
Justice in Nuremberg, which was the site of Hitler's
administrative and judicial offices and his stupendous mass
rallies.25 The defendants, which included Karl Brandt, Hitler's
personal physician, who was also Reich Commissioner for Health
and Sanitation and for which the case was named, were prosecuted
in a United States styled military court presided by a
three-judge panel consisting of Americans.
For eight months, witnesses from hospitals
and camps throughout Germany and Eastern Europe were brought to
Nuremberg to testify. Various transcripts and testimonies
revealed the atrocities and heinous acts that were committed in
the concentration camps against Jews, Gypsies, and other classes
of people the Nazis viewed as inferior. Medical experiments
listed under crimes committed in the guise of scientific
research included mustard gas, epidemic jaundice, sterilization,
typhus, incendiary bomb experiments, muscle and nerve
regeneration, and bone transplantation.26 Court records
described how numerous individuals died in agony and terror
under the cold eye of the physicians and scientists who designed
protocols and observed and recorded the manner of death. In the
freezing experiments, Nazi researchers conducted experiments in
the best way to thaw out Luftwaffe fliers forced to bail out
over frigid waters of the North Sea. They tested various thawing
techniques by exposing a number of prisoners to freezing
conditions and experimented with various methods of reviving
them.27 Other experiments they conducted for military purposes
included the seawater experiments in which researchers forced
subjects to drink seawater to determine how long pilots could
survive downed in the ocean and establishing the point at which
lungs exploded due to atmospheric pressures, an important issue
for fighter pilots seeking to avoid anti-aircraft fire. In the
incendiary bomb experiments, experiments were conducted at
concentration camps to test various pharmaceutical preparations
on phosphorus burns. Burns were inflicted on experimental
subjects with phosphorus matter taken from incendiary bombs,
which caused severe pain, suffering, and serious bodily
injury.28 Many prisoners were also subject to inoculations of
infectious disease pathogens.29 An estimated 100,000 human
beings died horrible deaths in the course of experiments at
Auschwitz, Buchenwald, Dacheau, Sachsenhausen, and other
camps.30
After eight months of hearing such
malicious crimes and acts done by researchers regarding human
experimentation, on August 20, 1947, the judges gave the
verdict, finding 15 of the 23 defendants guilty of war crimes
and crimes against humanity, including human experimentation
involving unconsenting prisoners.31 Seven were found not guilty
and one was acquitted of the charges of having performed medical
experiments but was found guilty of SS membership. Seven of the
fifteen found guilty were sentenced to death by hanging and the
other eight were imprisoned. Karl Brandt was one of the
physicians sentenced to death, and on the day of his hanging, he
exclaimed waiting beside the gallows, "It is no shame to stand
on this scaffold. I served my fatherland as others before me!"32
Even upon their deaths, a majority of the physicians and
scientists claimed that they did not do anything that was wrong.
The American judges at Nuremberg wanted to
do more than punish the Nazi researchers for their actions. They
sought to establish appropriate ethical standards for the
conduct of human experimentation that would be universal and
prevent Nazi atrocities from ever occurring again. Thus the
Nuremberg Code, a set of ten principles to provide ethics and
limitations on human experimentation, was born.
The Nuremberg Code was based on a
convergence of historical documents, testimonies, and standards
of ethical human experimentation in the Doctors Trial. The
principles of the Code were derived from the testimonies of two
medical expert witnesses for the prosecution, Leo Alexander and
Andrew Ivy, who were heavily influenced by the oaths, codes, and
writings of such great thinkers as Hippocrates. The Hippocratic
Oath, written some time between 470 and 360 B.C.E., had been a
significant ethos of medical practice and ethics and declared
that the physician should work to the best of his ability for
the good of his patients. The Oath stated, "I will follow that
system of regimes which, according to my ability and judgment, I
consider for the benefit of my patients and abstain from
whatever is deleterious and mischievous."33 The judges had
incorporated the medical experts' views into their final
judgement and enumerated the 10 principles of the Nuremberg
Code.
The Code provided guidelines for the
research setting, the integrity of the investigator, the
balancing of rights and benefits, and the most important
provision of all, the specifics of voluntary informed consent.
In fact, the very first principle of the Code declared that the
voluntary consent of the human subject is absolutely essential.
The first principle was followed by two paragraphs which laid
down the specifics of voluntary consent, stating that the person
involved in an experimentation should have the legal capacity to
give consent, situated to exercise free power of choice, given
knowledge and comprehension of the experiment, and be made aware
of the risks and dangers. The Nuremberg Code became the first
code to establish ethical standards for human experimentation
and govern human experimentation in international law. The Code
spurred on the development of other legal policies to govern
human experimentation based on voluntary, uncoerced, and
informed consent.34
The Nuremberg Code was not a flawless
document, and the judges did not consider therapeutic research
or subjects who were incompetent to make informed judgments in
its implementation. The judges did not consider the fact that
terminally ill patients might become depressed or unwilling to
undergo further treatment if informed of their prognoses. So, in
1964, the World Medical Association created the Declaration of
Helsinki, which drew a sharp line between therapeutic and
non-therapeutic research.35 The document did not obtain an
absolute requirement that informed consent be obtained in the
setting of therapeutic research and introduced the notion of
guardianship as means of obtaining consent from incompetent
subjects.36 The Declaration permitted the physicians, under
certain circumstances that he or she must defend, to waive the
requirement of informed consent. Nevertheless, the Nuremberg
Code was supposed to serve as the ethical basis for researchers
conducting experiments on human subjects. The Nuremberg Code was
supposed to be a guard against further atrocities and provide
protection for human subjects of research. One author stated:
The Nuremberg Code gave us a blue print for
a better world. It showed us that wanton aggression cannot be
permitted if we are to have a secure world and assured peace.
The Code showed us that we must reach the behaviors of
individual to create a better world. That we must penetrate the
veil of national sovereignty and punish the individual for
violations of international law if we are to give that law life
and vitality. Nuremberg also taught us that we need to recognize
individuals as having international rights, which are not
dependent on nation-state recognition.37
However, the United States, the main
initiators of the rules to protect human research subjects and
to prevent further atrocities, were the perpetrators of its own
heinous acts justified in the name of medical science. After
punishing Nazi researchers and establishing a universal law, the
United States allowed its researchers to conduct its own racial
and social hygienist experiments on minorities and other
disadvantaged populations that would be deemed unfit in the
terms of Nazi ideology.
Human experimentation has remained a
scientific dilemma in the medical arena. Human experimentation
refers to scientific experiments, in which humans are used as
subjects. The selection of human subjects for experiments
continues to present many challenges. Subjects in the
experiments can be nonconsensual or consensual. Unfortunately,
many times subjects are unwilling or unknowing subjects of the
experiments. Even more, the human rights of these individuals
have been almost disregarded by the physicians involved. Fifty
years ago, the Nuremberg Code called for the informed consent of
participants in human research.38 That same year penicillin was
recognized as the standard of care for syphilis. However,
researchers from the U.S. Public Health Service continued to
conduct a long running study in Tuskegee, Alabama, on the course
of the disease in African American men and chose not to provide
penicillin to study participants.39 The Tuskegee study remains
one of the most controversial experiments that has occurred in
the United States. The Tuskegee study has since become a
national symbol of racial and scientific exploitation.40 The
fact that the government was involved in the experiment casts
doubts on the future trust of the government by African
Americans, as well as distrust for the medical arena. The fact
that the study used poor African-American men at the governments
consent demonstrates a substantial conflict with the basic
rights that each citizen of the United States is supposed to
possess. Even more, the impact of the study continues to be felt
as the mistrust it generated in the eyes of African Americans.
The Tuskegee study began in 1932, when the
federal government promised four hundred poor African American
men -- all residents of Macon County, Alabama -- free treatment
for Bad Blood, a euphemism for syphilis, which was epidemic in
the country at that time.41 These men signed up with the U.S.
Public Health Service for free medical care. The service was
conducting a study on the effects of syphilis on the human body
and, at that time, the sexually transmitted disease was rampant
in Macon County, Alabama.42 The study ran from 1932-1972.
Throughout the four decades, the men in the study at no point
were ever told that they had syphilis. Nor, did the physicians
tell the syphilitic men that they might have infected their
wives, or doomed their children to a devastating congenital
infection.43 In fact, they were continuously told that they had
bad blood and were denied access to treatment, even for years
after penicillin came to use in 1947.44 Even more, the
physicians conducting the study went through extreme lengths to
ensure that the men would not receive therapy from any other
sources. It was not until the early 1970s that the popular media
disclosed the research and the study was terminated.
The fact that the study targeted African
American men raises another dilemma. The researchers targeted a
population to study a problem that was not confined to that
group. Even more, the men that were targeted were already
disadvantaged in terms of socioeconomic status and medical
condition.45 Because of the low educational status of the
majority of the patients, it was impossible to appeal to them
from a purely scientific approach.46 They were vulnerable
subjects who were given incentives for their participation. The
incentives offered by the Public Health Service included: free
physical examinations, free rides to and from clinics, hot meals
on examination days, free treatment of minor ailments, and a
guarantee that a burial stipend would be paid to their
survivors.47 The unfortunate thing is that free hot meals meant
more to the men than $50 worth of free medical examination. The
material incentives gave the men a support and a basic feeling
of good will towards the physicians. In reality, their
vulnerability was just the root of an unethical medical
experiment gone bad.
The issue of why the physicians did not
terminate the experiment after a cure was found remains one of
the most difficult aspects of the experiment to face. Throughout
the forty years of the study, it was periodically reviewed by
U.S. Health Service officials. In each case the study was
extended based on the argument that stopping the study, while
helping the individuals, would interfere with the benefits of
medical science of studying this untreated disease.48 Those
studying the men rationalized their point of view by claiming
that these extremely poor and sick men had the perks of medical
attention, free aspirin for their aches and pains, a free nurse
to watch over them, and would have their funerals paid for.
These physicians ignored the fact that penicillin was a
relatively inexpensive, safe, fast acting, wonder drug that
cured many infections, including syphilis.49
The effects of the study are limitless.
Over the years, the men suffered the effects of the untreated
sickness, which can cause brain damage and paralysis. Some men
infected their wives, and some of them, in turn, passed the
disease on to their children.50 By the time the study was
exposed in 1972, 28 men died of syphilis, 100 others were dead
of related complications, at least 40 wives had been infected
and 19 children had contracted the disease at birth. The U.S.
Department of Health, Education, and Welfare only stopped the
study after its existence was leaked to the public and it became
a political embarrassment.51
The Tuskegee experiment has left a legacy
of mistrust in the African American community. Louis Sullivan,
MD, president of Morehouse University School of Medicine in
Atlanta, explained that the Tuskegee study, more than any other
factor, resulted in the African American community's distrust of
the medical arena.52 Even more, it is such abuse that has caused
a significant number of African Americans impacted by HIV/AIDS
to refuse services from mainstream medical professionals. This
is only one of the consequences of the study. Others suggest the
Tuskegee study is the cause for the low participation of African
Americans in clinical trials and organ donation effort.53 In
essence, the study continues to cast a long shadow over the
relationship between African Americans and bio-medical
professionals. Some suggest that the apology by President
Clinton for the experiment will mark a renewed effort to heal
the wounds. However, others are unsure that after a quarter of a
century and six presidents later, whether the apology can make
change, if any.54 It is unfortunate that it took the Tuskegee
incident for the U.S. medical community to learn the lessons of
the Nuremberg Trials and the effects of human experimentation.
The Tuskegee syphilis study has been one of
the most widely cited examples of research in which human
subjects were not adequately protected. Even more, the fact that
the study was government sanctioned has led to many unfortunate
consequences, including a lack of trust by African Americans
towards the medical community and the U.S. government. Although
the apology by President Clinton was a necessary remedy, it
alone can not ensure that an atrocity such as Tuskegee will not
be duplicated. However, after the truth of the experiment was
revealed, clinical research policy reforms were enacted to
legally protect patients while binding science to specific rules
and regulations. Although this will not take away the pain of
the experiment, it will prevent others from becoming a target of
another unethical experiment (or will it?).
In 1952, at the Sloan-Kettering Institute,
Chester M. Southam injected live cancer cells into 396 inmates
at the Ohio State Prison. Half of the inmates involved were
black. Oddly enough, one of the sponsors of this experiment, the
National Institutes of Health, had also been a sponsor in the
Tuskegee experiments. Southam was temporarily stripped of his
medical license after injecting 22 elderly hospital patients
with cancer cells at Brooklyn's Jewish Chronic Disease
Hospital.55
Once again we see that at the heart of
protection against unethical medical experimentation is the
principle of informed consent. Not only is a patient insured the
right to consent, but they must also be consenting with full
knowledge and understanding of what is happening. They must be
aware of side effects, possibility of failure, recovery time,
etc. This is no longer a simple concept that can easily be
misconstrued. The key word is not consent, but rather both
informed and consent.
On November 28th, 1953, in New York City, a
psychotic and depressed Dr. Frank Olson threw himself out of a
tenth floor hotel window. Nine days earlier, Dr. Olson had been
unwittingly slipped 70 mcgs of lysergic acid diethylamide into
an after-dinner drink by a colleague, Dr. Sidney Gottlieb, head
of the CIA's Technical Service and key orchestrator in MKULTRA,
to determine the effects of LSD on unknowing subjects. After
ingesting 70 mcgs of LSD, Dr. Olson entered a nine-day state of
psychosis that culminated with him jumping through a screened
glass window to his death. In defense of his actions, Dr.
Gottlieb and others in Operation MKULTRA said that
non-consensual human experimentation with LSD was necessary to
gather accurate information about the drug's effects.56
Two years later in San Francisco Captain
George White of the OSS sat behind a two-way mirror, martini in
hand, observing the effects that LSD has on sexual behavior for
Operation Midnight Climax. Operation Midnight Climax was a
sub-project of MKULTRA. Captain White hired prostitutes to lure
unknowing patrons into a CIA-run brothel fully equipped with
surveillance cameras, audio bugs, and two-way mirrors. At these
safe houses, the unknowing subjects would be given beverages
laden with LSD. CIA agents would then observe the effects that
LSD and sexual intercourse have on various interrogation
technique.57 The same reason given for the experiment on Dr.
Olson was supplied for these actions. How can this be legal?
Both of these cases of human experimentation without informed
consent were entirely legitimized and funded by the Central
Intelligence Agency.
Operation MKULTRAs ultimate goal was
achieving a state of mind control through drugs, electronic
devices, or radiation. Unlike most other instances of
non-consensual human experimentation, Operation MKULTRA
transcended race and economic class in most of its subject
gathering processes.58 This pursuit for a Manchurian Candidate
stretched laws dealing with the jurisdiction as designated in
the National Security Act of 1947 that established the CIA in
addition to the infringement of basic human rights.
The infringement of human rights laws and
various laws dealing with non-consensual human experimentation
was justified by the CIA through the rationale that
experimentation of individuals with out consent was necessary to
collect accurate results. In a 1954 memo, then CIA Director,
Richard Helms justifies this by stating: "Most of our difficulty
stems from the fact that the individuals subjected to testing
must be unwitting... In the circumstances of potential
operational use of this technique, it is virtually certain that
the target will be unwitting".59
Those accurate results would then be
applied towards research with purpose of insuring national
security. This rationale proved inconsequential when the
operation was exposed through a number of Senate hearings in the
1970's. The Kennedy Hearing of 1977 actually began the process
towards Executive Order 12333 that prohibits the experimentation
on humans without consent by intelligence agencies.
Operation MKULTRA was initiated on April
13, 1953. It was the next step of a smaller operation called
BLUEBIRD that was spawned by a response to rumors that the
Chinese and Soviets were far ahead of the U.S. in research
dealing with mind control. According to the few documents on the
operation that were not destroyed by order of CIA director
Richard Helms in 1973, MKULTRA was an umbrella project that
contracted 149 sub- projects to various universities. According
to Admiral Stansfield Turner, Director of Central Intelligence,
19 sub-projects involved the drugging of human subjects without
informed consent.60
Only top officials knew the exact purpose
of MKULTRA. Most of the doctors involved were only aware of the
particular sub-projects allocated to them from operatives. Some
of these officials found themselves to be unwitting guinea pigs.
It was common practice amongst the upper echelon officials
within the project to slip each other doses of various drugs,
LSD being the most prevalent, to see the effects that it has on
subjects not knowing that they have been drugged. After initial
experiments, Dr. Gottleib, the man responsible for the death of
Dr. Olson, concluded that while it has little use as an
interrogation drug, LSD could be used on leaders to create
public humiliation. They even began planning an attempt to slip
Fidel Castro, dictator of Cuba, LSD to decrease his machismo
image.61
After discovering the files on MKULTRA that
were not destroyed in 1973, the more friendly CIA administration
headed by Admiral Stansfield Turner handed them over to Congress
in 1975. The struggle to obtain these files was primarily won
through the usage of Freedom of Information Act. The Freedom of
Information Act, passed in 1966, allows private entities more
access to information about government activities.62 Two years
later, a special hearing by Senator Edward Kennedy took place
that examined the Operation MKULTRA and its violations of the
CIA jurisdiction guidelines within the National Security Act of
1947. During the hearing, it was revealed that the above stories
were true in addition to many other violations of already
established informed consent laws. Informed consent, as used in
the hearing, can be defined as full processes of disclosure,
comprehension, and voluntary agreement to participate.63
Citing the National Security Act, Dr.
Gottlieb refused to inform the hearing of information not
otherwise provided in the remaining files on MKULTRA. When
confronted about various cases of human experimentation without
informed consent, Dr. Gottlieb and other CIA operatives working
on MKULTRA stated that the utilization of unwitting subjects was
necessary. The rationale for such testing was "that testing of
materials under accepted scientific procedures fails to disclose
the full pattern of reactions and attributions that may occur in
operational situations".64 They stated that the gathering of
such data, and its strict secrecy from all but top CIA
officials, was crucial to national security, and therefore
protected under the National Security Act of 1947.
As a result of the Kennedy Hearing of 1977,
then President Carter began the process of drafting legislation
directly prohibiting such abuses of human rights through
non-consensual experimentation for the purpose of gathering
intelligence information. The attempt to narrow the potential
for future abuse from the intelligence community was finalized
by President Reagan's Executive Order 123333. Among other items
listed that streamline intelligence jurisdiction, the order
states:
No agency within the Intelligence Community
shall sponsor, contract for or conduct research on human
subjects except in accordance with guidelines issued by the
Department of Health and Human Services. The subject's informed
consent shall be documented as required by those guidelines. 65
It is true that Operation MKULTRA took
place. Dr. Olson did jump out of a ten-story window to his death
due to a drug-induced psychosis initiated without consent by the
CIA. Prostitutes on CIA payrolls did lure unknowing bar patrons
to CIA funded brothels where they were slipped LSD and observed
while having sexual intercourse. At the time, both activities
were arguably legal due to the fact that the information
gathered was supposedly crucial to national security because of
its relevance to research in mind control. However, once
information about MKULTRA went public, hearings commenced and
Executive Order 123333 was passed prohibiting, in theory, human
experimentation without informed consent by an intelligence
agency for any reason.
In 1970, it was made evident that men were
not the only people at risk of medical experimentation. Children
too are very susceptible to mistreatment. The main reason for
children being at risk of experimentation is their inability to
consent for themselves. Adults must give consent for children,
but they can be misled, as was the case at a free child-care
program at Johns Hopkins University.
Over 7,000 young boys were used in an
experimental three-year study that could have labeled them as
criminals indefinitely. The majority of these boys came from
poor, African American families. These experiments were once
again funded by the National Institute of Health, and were
supposed to test for anemia and other medical problems. However,
in actuality, the blood was screened for the extra Y chromosome.
Such screening enabled those boys who were XYY to be labeled as
at risk criminals. It was believed at the time that XYY boys
were more aggressive and at risk of becoming criminals.
Similar experiments were conducted on 6,000
young men in institutions for abandoned children. Once again the
majority of these boys were African American. When parents were
involved, their permission to conduct tests was often coerced.
The project director, Digamber Borganokar, was not a physician,
and his assistants were merely undergraduate psychology majors.
Despite certain allegations, Johns Hopkins University had never
granted permission for the experiments. Laws protecting people
against such incidents were already in effect, but had done
nothing to prevent such experiments.66
In Philadelphia, Doris Jackson had the
opportunity to tell CBS America Tonight that she had been
refused the right to see her son after his death, and when she
finally did, she discovered that his brain had been removed.
This occurred in 1987. Pennsylvania had a doctrine of implied
consent. This basically stated that unless a patient or subject
has signed a written document saying the contrary, then consent
has been implied. Unfortunately, few people were aware of the
law and felt they were denied the right to object. Researchers
claimed that the organs these families donated went towards
research, however, that was not always the case. More often than
noted, these organs were going towards building the resume of
students not because there was a need for the study, but rather
because the students involved wanted self-gain.67 Implied
Consent has opened up an entirely new argument for the precedent
set by the Nuremberg Code. Can implied consent be informed
consent?
Throughout the last few decades, there have
been multiple experiments carried out by the United States
Military. The Navy was responsible for spraying bacteria over
San Francisco, under the claim that the bacteria was harmless
and was merely a simulated attack. However, many San Francisco
residents became ill. The U.S. military also allegedly released
harmless gasses over six U.S. and Canadian cities once again
under the cover up of studying a simulated attack. These
harmless gasses, however, resulted in respiratory problems for
many non- consenting civilians. Twelve people died when Tampa
Bay, Florida experienced a sharp rise in Whooping Cough cases
after a CIA test.68
In 1985, the courts ruled against a
military liability case, reasoning that by doing so they would
affect the chain of command. A former U.S. Army sergeant
attempted to bring a lawsuit against the Army for using drugs on
him, without his knowledge, in United States v. Stanley, 483
U.S. 669 (1987). Justice Antonin Scalia wrote the decision in
this case, which absolved the U.S. military from any liability
in cases where the military might conduct medical experiments
without informed consent. It also had the effect of absolving
all past wrong doings as well. Conservative Justice, Sandra Day
O'Connor, who dissented, had cited principles of human rights,
and concepts formulated under the Nuremberg Code in an attempt
to hold military commanders responsible for their deeds.69
The Gulf War Syndrome was thought to be a
direct result of the Gulf War. The Gulf War Syndrome is a title
that has been given to a wide array of symptoms ranging from
mere skin diseases to attacks on the nervous system. 1.7 million
soldiers were sent to the Persian Gulf in 1990. Twenty-two
percent of these soldiers were African American. It is widely
believed that the Gulf War syndrome stems partially if not
entirely from the experimental vaccines given to U.S. soldiers.
Soldiers were forced to take these vaccines under federal law
but were ordered to deny the fact that the vaccines were indeed
experimental. Soldiers have had dishonorable discharges from the
military for refusing to take the vaccines. The media has
focused on the possibility of the syndrome stemming from
exposure to chemical weapons; however, 33% of soldiers infected
with the Gulf War Syndrome had never left the United States.70
In conclusion, human medical
experimentation still remains a dilemma in the United States.
Legal developments to protect citizens from experimentation
without informed consent have been ineffective. The Nuremberg
Code, which set the precedent for obtaining informed consent,
was not able to keep human experimentation without informed
consent from occurring, especially when the experiments targeted
minorities and disadvantaged populations. These experiments were
able to continue and occur because the United States held the
same racial hygienists views as the Nazis concerning people that
were fit and unfit.
After establishing the Code, the U.S.
entered into the Cold War hysteria, competing against Russian
and Chinese Communists. Government officials, scientists, and
doctors worked vigorously in trying to surpass the achievements
and accomplishments of the Communist countries to prove, in ways
similar to the Nazis' actions, that a Democracy was the
quintessential form of government and that the United States was
the best country in the world. Already plagued by a history of
racism and a history of prejudice toward the poor, the United
States continued and began to conduct experiments on people they
deemed to be unfit to place the U.S. in spot #1 of the Cold War
competition and to improve the livelihood of the dominant
culture. To Americans, as evident by the experiments conducted
after Nuremberg, African-Americans, poor people, soldiers, the
under class, like alcoholics, and other disadvantaged
populations were considered to be lives worth not living if it
meant advancing and saving the lives of the dominant,
advantaged, white, and superior cultures. Many government
officials and agencies and medical associations were able to
continue to perform these experiments because they took
advantage of populations who did not have a political voice and
little knowledge of policies promoting protection for their
general welfare. These agencies and associations also deceived
many participants and rationalized many of their actions by
saying that they were promoting national security. Since the
passage of the Nuremberg Code, American society has been plagued
by human experimentation incidents such as the incident that
occurred in Tuskegee.
The Tuskegee Syphilis Study began in 1932,
years before the adoption of the Nuremberg Code. However, the
study continued until 1972, which was well after the Nuremberg
Code was created. Even more, the study continued even after
penicillin was discovered as a cure for syphilis. As the
awareness of the benefits of penicillin grew, the researchers
saw a greater urgency in continuing
"a-never-again-to-be-repeated-opportunity. "71 Yet, doctors
claimed that they were merely doing their jobs. John Heller, MD,
then director of the Public Health Services of Venereal Diseases
stated, "For the most part, doctors and civil servants simply
did their jobs. Some merely 'followed orders', others worked for
'the glory of science'". However, was this really the case? To
deny that race played a role in the Tuskegee Study is naive. All
600 subjects (399 experimentals and 201 controls) were black;
the Public Health Service directors and most of the doctors were
white.73
In essence, the Tuskegee Study was simply
an unethical and immoral experiment on disadvantaged subjects.
Even more, it was a premeditated genocide on a disadvantaged
group, who was simply uninformed of what their participation
really consisted of. The Tuskegee Study represents the
misfortune of human experimentation that targets disadvantaged
or vulnerable groups. Unfortunately, race played an important
part of the disadvantage for these subjects. Human
experimentation of this kind should have never been allowed to
occur. However, if the Nuremberg Code could not prevent it, what
could have?
Given the atrocities committed on unknowing
subjects during project MKULTRA, the CIA, in addition to other
intelligence groups, had almost as much freedom as the Nuremberg
doctors when it came to human experimentation. The CIA
legitimized their actions under MKULTRA by explaining that the
results of the experiments were detrimental to national
security, thus being entirely legal according to their 1947
charter. When the United States Congress learned about the
horrors committed under Project MKULTRA during the 1977 Kennedy
Hearings, the process towards Executive Order 123333 began. This
order made it illegal for all intelligence agencies to practice
experimentation on unknowing subjects.
However, most current medical experiments
performed on humans have involved the military, which has free
reign to do as it wishes because of the precedent set by the
Supreme Court decision in 1985. Throughout the 1980s and early
1990s, there were a number of incidents in which the U.S.
military was allegedly involved in conducting experiments on
American citizens and soldiers, including the Gulf War Syndrome.
Presently, fewer experiments are being
carried out because the concept of informed consent is beginning
to be accepted. Informed consent is now recognized by more
government agencies and medical associations than in the past.
There have been current developments in the sphere of medical
experimentation, such as a development that came with a case
concerning the studies at Johns Hopkins University, stating that
parents are legally responsible for children under 18 and must
therefore be the persons giving informed consent when children
are involved in medical experiments. There have also been
developments in the military involving the Gulf War Syndrome.
Perhaps, the current crisis concerning the Gulf War Syndrome
will demand results and progress in the realm of monitoring and
controlling human medical experimentation. There has been a
decrease in the number of human medical experiments performed
without informed consent. Hopefully, the next set of
developments will put more reasonable controls on the military.
1 TriJet. Germ Warfare: The Hall of Shame
(1997) http://home.earthlink.net/~bkonop/GermIncidents2.html
2 Annas, George J. and Michael A. Grodin,
ed. "Introduction." The Nazi Doctors and the
Nuremberg Code. New York: Oxford University
Press, 1992.
3 Leaning, Jennifer. "War Crimes and
Medical Science." British Medical Journal. Vol. 313, Issue 7070,
5pp. EBSCO
Host. 7 Dec. 1996. Hereafter, cited as
Leaning.
4 Ibid.
5 Moreno, Jonathan D. "The Dilemmas of
Experimenting on People." Technology Review,
July 97, Vol. 100, Issue 5, 6pp. Hereafter,
cited as Moreno.
6 Ibid.
7 Proctor, Robert N. "Nazi Doctors, Racial
Medicine, and Human Experimentation." The Nazi Doctors and the
Nuremberg Code. Ed. George J. Annas and Michael A. Grodin. New
York: Oxford University Press, 1992. Hereafter, noted as
Proctor.
8 Ibid.
9 Proctor, Robert N. "The Racial Hygiene:
The Collaboration of Medicine and Nazism." Medicine, Ethics, and
the Third Reich: Historical and Contemporary Issues. Ed. John J.
Michalczyk. Kansas City: Sheed & Ward, 1994. Hereafter, cited as
Racial.
10 Ibid.
11 Racial, 35.
12 Ibid, 36.
13 Proctor, 20.
14 Ibid.
15 Racial, 37.
16 Ibid, 38.
17 Ibid.
18 Proctor, 39.
19 Ibid, 27.
20 Moreno, 2.
21 Proctor, 27.
22 Ibid, 26.
23 Moreno, 2.
24 Grodin, Michael A. "Historical Origins
of the Nuremberg Code." The Nazi Doctors and the Nuremberg Code.
Ed. George J. Annas and Michael A. Grodin. New York: Oxford
University Press, 1992.
25 Leaning, 1.
26 Ibid.
27 Moreno, 2.
28 "Judgement and Aftermath." (Historical
Notes) The Nazi Doctors and the Nuremberg Code. Ed. George J.
Annas and Michael A. Grodin. New York: Oxford University Press,
1992.
29 Grodin, 132.
30 Moreno, 2.
31 Grodin, 132.
32 Mielke, Fred and Alexander Mitscherlich.
"Epilogue: Seven Were Hanged." The Nazi Doctors and the
Nuremberg Code. Ed. George J. Annas and Michael A. Grodin. New
York: Oxford University Press, 1992.
33 Ibid, 123-33.
34 Ibid.
35 Moreno, 4.
36 Leaning, 2.
37 King Jr., Henry T. "The Meaning of
Nuremberg." Case Western Reserve Law Review, Winter98, Vol. 30,
Issue 1, 5pp. EBSCO Host15 Apr. 1999. http://www.epnet.com
38 Wolinsky, H. "Steps Still Taken To Undo
The Damage of "'America's Nuremberg'". 27 Apr 1999.
http://www.acponline.org/journals/annals/15aug97/currnazi.htm.
Hereafter, cited as Wolinsky.
39 Ibid.
40 Levine, J. "Sour Legacy of Tuskegee
Syphilis Lingers". Date Visited: 27 Apr 1999. Last Modified:
Unknown. Hereafter, noted as Levine. http://www.epnet.com
41 America's Dirty Little Secret. Home page
17 Sept 1999. Last modified unknown. http://www.aabhs.org/tusk.htm
42 Ibid, 1.
43 O'Grady, Mary. "Never Forget Tuskegee."
Progressive.org 16 May 1997 Progressive.org 31 Mar 1998.http://www.progressive.org/mpogrady.htm
44 Levine, 2.
45 Rose, S. "Selecting Human Research
Subjects. Protecting Human Subjects". 30 Aug 1999.http://www.er.doe.gov/production/oher/humsubj/index.html
46 Rivers, E., Schuman, S., Simpson, L.,
and Olansky, S. Twenty Years of Followup Experience in a Long
Range Medical Study. Resources on Non-Consensual Human
Experimentation. Home page. 5 Feb 1998. 12 May 1998 http://www.dc.peachnet.edu/~shale/humanities/composition/assignments/experiment/rivers.html
47 America's Dirty Little Secret, 1.
48 Brent, S. The Tuskegee Syphilis Study.
Last Modified: unknown. http://showme.missouri.edu/~socbrent/tuskegee.html
49 Boehm, Frank. "Tuskegee." Dr. Frank
Boehm's Essays. Home page. 11 Jul. 1999. Last Modified:
unknown.http://dr-boehm.com/tuskegee.htm
50 Peterson, Jonathen. "Close Up: Tuskegee
Experiment's Legacy is the Spread of Suspicion". Seattle Times.
17 Oct.1977. http://www.seattletimes.com/extra/browse/html97/alttusk051697.html
51 Brent, 2.
52 Wolinsky, 2.
53 Guenther, Kim. "A Request for Redress of
the Wrongs of Tuskegee". Date Visited: 12 Feb 1999. Last
Modified:unknown. http://www.med.virginia.edu/hslibrary/historical/apology/report.html
54 Boehm, 2.
55 Washington, Harriet A. "Unethical
Testing Targets Blacks and the Poor" (October 1994)http://www.msbet.com/content/live/833.asp
56 U.S. Senate. 1977 Senate Report on
MKULTRA. 1977. Parascope. Home page. 19 April. 1999.
Parascope.Hereafter, noted as Senate. http://www.parascope.com/ds/documentslibrary/documents/mkultrahearing
57 History House. LSD and the CIA. Home
page. 19 April, 1999. History House. 21 April,1999. Hereafter,
noted as History. http://www.historyhouse.com/stories/lsd.htm
58 Senate, Opening remarks.
59 Helms, Richard. Memo. 17 Dec. 1963. Acid
Dreams Document Gallery. Home page. Levity Books. 21 April.
1999.http://www.levity.com/aciddreams/dox.html
60 Senate.
61 History.
62 A Citizen's Guide on Using the Freedom
of Information Act and the Privacy Act of 1974 to Request
Government Record. Home page. Tennessee Criminal Law Defense
Resources. 21 April. 1999. http://www.tncrimlaw.com/foia_indx.html
63 Guidelines for Writing Informed Consent
Documents. Home page. 12 April. 1999. Helix Systems 21 April.
1999. http://helix.nih.gov:8001/ohsr/info/finfo_6.phtml
64 Senate, App. A.
65 Executive Order 12333. 4 Dec. 1981.
Granite Island Group. Home page. Granite Island Group. 21 April.
1999. http://www.tscm.com/EO12333.html
66 MSBET 10-11.
67 Washington, 12.
68 TriJet, 2.
69 TriHet, 4.
70 MSBET 9.
71 Wolinski, 1.
72 Ibid, 2.
73 America's Dirty Little Secret, 1
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