I have always felt that issues should be judged by the context of their times. For some issues, however, context provides no justification. Thankfully, the field of medical ethics has evolved into a robust discipline, and there is an enormous need for it. I have read defenses of prior ethical lapses, and even some recent ones, suggesting that context matters. If a 3 month placebo-controlled study is conducted in the developing world testing a medicine that was highly effective against a serious illness, are the ethical dimensions considered and respected? Were the pharm companies choosing this study locale as a cheap test run for their drug, which will ultimately be marketed in the west? Is it ethically problematic not to provide additional medications to ill subjects after the 3 month trial ends? Can we be assured that a rigorous informed consent process was followed? Sadly, outrageous practices have been reported in the very recent past.
Our president and secretary of state recently and rightfully apologized to Guatemala for American experiments performed there in the 1940s when patients were intentionally infected with syphilis. These patients were mentally ill. While I can concoct a distorted and tortured rationale that would justify this reprehensible practice, such reasoning passes no threshold of decency. Some behaviors and practices are always wrong, in any context.
How can decent folks behave indecently? We have seen in the Holocaust how ordinary folks can tolerate, and even perform, evil during the week, and then attend religious services on Sunday. Many of these dark acts were committed by physicians, who are sworn to heal and to comfort. Here’s a perspective on this issue from a man who is known as the conscience of the world.
These are frightening notions. First, they suggest that we may not have innate inclinations to do good, despite our belief that we are all equipped with powerful superegos. If we were all good by nature, then we wouldn’t need such an expansive criminal justice system and thousands of laws telling us what not to do. The reason that the bible is replete with ‘Thou shalt nots’, is because human behavior is often ‘I shalt’. Secondly, these repeated ethical lapses and catastrophes point out that all of us are vulnerable to do wrong, even when we know what the right choice would be. While we might like to think we would push back against a black tide, it is less certain what we would truly do in that situation. Would we risk a job, for example, to take a righteous stand for another person?
I recognize that medical ethics addresses tough issues, where one person’s rights are weighed against another. The resolution of ethical issues yields winners and losers. Yet, despite these controversies, we need a firewall separating what we must do from what we must never do. The argument that the ends justify the means must be resisted. What American scientists did in Guatemala nearly seventy years ago was appalling and morally indefensible. It was wrong then, it is wrong today and it will be wrong tomorrow. The president has just ordered a review of all research involving human subjects being funded by the federal government to assure that medical ethics are being properly practiced. Recent history demonstrates that oversight is necessary. Third world citizens deserve first class ethics.