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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 in Germany 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
worth living. 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 Fuhrer of 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, and flat feet were more
common among Jews than non-Jews18 So began one of the greatest
atrocities of mankind when Nazis enforced extermination of Jews
and other populations by gassing them in concentration camps.
The Nazis used physicians and scientists to carry out their
sadistic policies and exploited both the intimacy and authority
of traditional physician-patient relationship. Doctors served as
executors and performed selections of people to be killed in the
concentration camps. In fact, a decree was issued in 1943 saying
that only physicians trained in anthropology could perform
selections at concentration camps. 19
Medical professionals also used the Nazi Party for their
advantage and benefit. Ambitious researchers used the racial
hygiene policies to their advantage. The researchers, many of
whom were members of the Nazi Party, could avail themselves on
experimental subjects without limitations and could justify and
rationalize their actions by the notion 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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