Ethical Problems and Consequences of Research Procedures - Essay Example

Ethical Problems and Consequences of Research Procedures Introduction Research undertakings in several disciplines such as Medicine, Psychology, Sociology, Anthropology, and others where human or other living subjects are used, have a significant element of ethics involved in conducting the investigations. The professional code of ethics states that if a research subject is at risk of physical, mental or legal harm, then the subject must be informed of the rights and responsibilities of both researcher and subject (Andersen & Taylor, 48). Two research studies in the history of science integrated with sociology, which demonstrate ethical violations are a Dental Experiment on mentally handicapped people in Vipeholms Hospital in Lund and the Tuskegee Syphilis Study conducted at the Tuskegee Institute in Macon County, Alabama, a historically Black college on poor, illiterate, colored sharecroppers. The purpose of this paper is to summarize and critically discuss the two research studies above, analysing the reasons, alternatives, lack of reaction from the government, and whether the experiments could be justified on any grounds. Discussion Ethical problems in research studies arise from the processes and consequences of research procedures. These ethical issues can be identified by a number of distinctive features, and the extent of their implications may vary according to the level of the research process. These issues include the “treatment of research participants, responsibility to society, and integrity in the collection, analysis and reporting of data” (Kimmel, 1988: 40-41). The Dental Experiment on Mentally Handicapped People in Vipeholms Hospital, Lund. Dental health in Scandinavia was extremely poor in the 1930s, and there was wide prevalence of dental caries even in three-year-old children. A comprehensive socio-medical study in the northern part of the country indicated that poor diet was one of the main causes of disease. Some important governmental decisions included the resolution in the Swedish parliament that a Public Dental Service should be organized. When the service was planned, the cost appeared to be exorbitant since the need for dental care was tremendous. The Parliament proposed the need for prevention; and the Swedish government asked the medical board to perform in collaboration with the Dental Institute a general investigation regarding the measures needed to be taken to decrease the frequency of the most common dental diseases in Sweden (Krasse: 1785). Committee work began comprehensively which led to a decision to perform a clinical study on diet and dental caries at the Vipeholm Hospital, a hospital for individuals with mental handicaps, located outside the University city of Lund. The concept was that an institution for mentally disordered people would contain a large number of virtually permanent patients. This was considered to be ideal in providing an opportunity for “long-term nutritional studies to be performed in well-controlled conditions” (Krasse, 2001: 1785). Until that time, there were no research studies that had investigated basic questions such as whether dental caries indicated disturbance in the general condition of the patient such as due to a deficiency disease, or was it due to local oral factors related to the diet. For the purpose of large scale reductions in carbohydrate intake in anti-caries campaigns a definite study was needed, for more information on the carbohydrate-caries relationships. The duration of the research study was from 1945 to 1954, and was divided into three phases: clinical experimental studies of the relationship between diet and dental caries, supplementary studies, and special studies. The Medical Board supervised the research. After the patients were selected and the recording method was developed, this was followed by the vitamin study during which different supplements were given to various groups. Low caries activity was found with the basic diet containing sugar in a quantity that represented half the average consumption in Sweden and the usual amount of starch. None of the supplements were found to have any effect on caries activity (Krasse: 1785) The next part of the study, the Carbohydrate Study, was to examine how caries activity was influenced by the ingestion of carbohydrates under controlled conditions such as under extreme conditions with regard to carbohydrate consumption. In Carbohydrate Study I, sugar in solution or in sticky form were served to the inmates at mealtimes of the mentally ill patients’ hospital; and between meals toffees were served. In Carbohydrate Study II the types of sweets, with the exception of toffeees, were the same consumed outside the institution, and the daily amount was similar to that consumed by children in Lund. The variation observed in caries susceptibility in the Vipeholm patients in the two studies, with high impact of caries in Study II were significant research findings. “The publication of the Vipeholm Study led to an information campaign about the risk in caries in conjunction with the frequent consumption of sugar” (Krasse, 2001: 1787). Ethical violations form the basis of the study conducted on the mentally ill. The reasons for choosing the mentally ill patients as a test subject. The mentally ill were all found in one group, staying in the same place, and would be available in the long-term for the entire course of the research study. The alternatives that were present for the researchers. The researchers could have performed the same research study on normal adults who willingly gave their informed consent, who could have been paid for their volunteering in the research. Reasons for lack of reaction from staff, government. The Swedish government asked the Medical Board to conduct an investigation to determine the measures needed to be taken to decrease the frequency of the most common dental diseases in Sweden (Krasse: 1785). The staff of the Vipeholms Hospital cooperated with the study on the mentally ill patients, expecting the results of the study to help them in determining the care of their wards towards prevention of dental caries. Can the experiment be justified? The researchers attempt to justify their research on mentally ill patients by stating that “the end sometimes justifies the means, and it is easy to be wise after the event” (Krasse, 2001: 1788). However, these excuses cannot hope to justify the breach of ethics and the harm caused to the mentally ill in a deceptive manner, and without their informed consent. The Tuskegee Study: A Syphilis Experiment on Black Men The Tuskegee Study is considered to be one of the most well-known cases of research abuse in the United States and a nontherapeutic experiment on humans of the longest duration in medical history (Kimmel: 52). For a period of forty years, between 1932 to 1972, the United States Public Health Services (PHS) conducted an experiment on 399 black men in the late stages of syphilis. These men were illiterate sharecroppers from one of the poorest regions of Alabama. They were deceived into believing that they were to receiving free treatment for their condition of “bad blood”, were not told what disease they were suffering from, or of its seriousness. A control group of an additional 201 black men without syphilis were also enlisted in the research. The were carefully prevented from receiving any treatment, although penicillin had been discovered in the 1940s, and was the first real cure for syphilis. However, the experiment was deceptively carried out under the guise of a demonstration to provide treatment, in order to gain community support. The main aim of the experiment was to observe the effects of the disease on Black men, and record the progression of its impact, till the subject died from lack of treatment. Since the data for the experiment was to be collected from autopsies of the men, the subjects were deliberately left to degenerate under the ravages of tertiary syphilis. This led to tumors, heart disease, paralysis, blindness, insanity, and death; all of which the men painfully suffered from before dying untimely and preventable deaths. The subjects were made to endure painful spinal taps under the guise of “free treatment” for which they readily agreed. Also, the fact that autopsies would be required was concealed from them (Brunner, 2007). Though it quickly became apparent that the infected subjects were suffering from more medical complications than the controls, and mortality rates were high due to syphilis related conditions for the untreated subjects, the PHS continued to prolong the experiment indefinitely, vicitmizing not only the subjects but many of the wives also who fell prey to the sexually transmitted disease, and many children who were born with congenital syphilis. Why only black men were picked for the study. The United States Public Health Service (PHS) wanted to discover how syphilis affectged blacks as opposed to whites. The theory was that whites experienced more neurological complications from syphilis, while on the other hand, blacks were more likely to suffer cardiovascular damage. There is no definite reason why this information was required, since clinical treatment of syphilis would not be impacted in any way by this knowledge (Brunner, 2007). Why there were no reactions from staff / government. Since the staff and government supported the experiment, they did nothing to put an end to the atrocity committed on the unfortunate blacks. Some of the doctors involved in this research were African Americans, further for most of the forty years of this study a black nurse, Eunice Rivers was a significant person, and the Tuskegee Institute and other predominantly black institutions participated in the experiment conducted on the illiterate black population. However, the racism involved in this entire research cannot be minimized in any way. The United States government, the PHS which advocated the study as one of great merit, white doctors and even the Surgeon General of the U.S. who participated and enticed the men to remain in the experiment, rewarding them with certificates of appreciation after twenty-five years in the study were all part of the research team. Moreover, governmental agencies lacked established policies for reviewing experimental procedures, obtaining subjects’ consent was non-existent, and there were no effective controls to protect the rights of research participants (Brunner, 2007). Conclusion This paper has highlighted two research studies that were conducted unethically on vulnerable populations, both undertaken by means of deceptive procedures with an aim to obtain data from the evidence. The paper has analysed the salient points about the research studies, government involvement in both cases, and to what extent the experiments can be justified. The purpose of ethical and legal requirements to obtain a patient’s consent prior to undergoing dental treatment is to “respect and protect patient’s autonomy, right to self-determination and specifically their right to choose what is done to their body” (Lambden, 2002: 83). Dental decision making involves both dental and personal decision making, and dentists cannot replace the patient’s informed personal decisions with their own dental judgements. Besides treatment, this is true for ethics in dental research also, where the subjects’ informed consent is necessary (Lambden: 90). For all research studies, the professional code of ethics states that if a research participant is at risk of physical, mental or legal harm, then the individual must be informed of the rights and responsibilities of both researcher and subject (Andersen & Taylor, 48). Moreover, vulnerable populations such as the mentally ill, and the poor, illiterate blacks in the Tuskegee Study should never be exploited for self-gain. An ethical approach in research studies will go a long way in ensuring fairness and justice for all. Works Cited Brunner, Borgna. The Tuskegee syphilis experiment: the U.S. government’s 40-year experiment on black men with syphilis. Website of infoplease. 2007. Retrieved on 29th September, 2008 from: http://www.infoplease.com/spot/bhmtuskegee1.html Andersen, Margaret L. & Taylor, Howard F. Sociology: understanding a diverse society. 4th Edition. California: Thomson Higher Education Publications. 2006. Kimmel, Allan J. Ethics and values in applied social research. California: Sage Publications, Inc. 1988. Krasse, Bo. The Vipeholm dental caries study: Recollections and reflections 50 years later. Journal of Dental Research. 80.9 (2001): 1785-1771. Lambden, Paul. Dental law and ethics. The United Kingdom: Radcliffe Publishing. 2002. 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