Comparing Ancient Egypt and the United States on Their Various Views of the Origin of Humankind, Research Paper Example

An important issue in research ethics is informed consent (Williams et al: 436) which in healthcare settings comprises more than a mere agreement by the patient to a procedure. An obligation falls on the attending hospital personnel to provide the patient with sufficient information such that he or she understands risks associated with his situation to have the opportunity to choose what shall or shall not be done to them insofar as they participate. In the film, Miss Ever’s Boys, the issue of professional ethics is central and this paper will reflect on some of the actions such that were they to occur today, the violator would be liable to lengthy jail time if convicted.(“Miss Evers Boys” 1997)

The film tells the story of the Tuskegee experiment, a U.S. Federal Government secret medical experiment on poor African Americans between the years 1932-1972. The study was to observe the effects on African Americans with untreated syphilis. The story is told from the perspective of the small town nurse Eunice Evers who is well aware of the lack of treatment, but feels her role is to console the involved men, many of whom are her direct friends and one whom she knows from elementary school and ultimately has a romantic relationship with.

The Belmont Report of 1975 lays out specific recommendations for health care research by professionalism health care settings and considered the boundaries separating biomedical and behavioral research, the risk-benefit of research to humans; guidelines for subject selection; and, the nature and definition of informed consent. As noted earlier in essence, the notion of informed consent must of needs be have several constituent components, namely information, comprehension, and volunteerism.  Providing the subject with as much information as they need to understand risks or benefits to the procedures or research is necessary for them to make informed decisions about their health. They can only make these decisions if they are understand the nature of the research. So for example if the subject is mentally or physically challenged or otherwise vulnerable due to their condition, then extra care must be taken to protect them. Children come to mind as do those with dementia for example. They must also not be coerced into participating and ought to be free to volunteer to participate or opt out should they choose. There should be no compulsion to participate due to emotional pressure. In other words, as Williams et al in their discussion on culturally sensitive communities, they should come to the research by their free will with the full knowledge of what they are doing, understand the risks associated with their choice if there are any, and what benefits might accrue should there be any. (Belmont; Williams et al: 436, 438)

The film, Miss Ever’s Boys, will serve to highlight what violations of ethical behavior occurred during the study had the recommendations of the Belmont Report been implemented during the term of the study which ran from 1932 until 1972. The study itself is based on deception when Dr. Rufus goes to Washington and learned that he was to keep the nature of the study a secret. He was not allowed to inform the men that their syphilis would remain untreated. They decided that the men ‘have to understand that we want to get them well’ to guarantee their participation. The men believed they would be given vaccines to treat their syphilis. (Miss Evers Boys” 1997)

There is a scene near the beginning of the movie which puts the importance of informed consent into clear perspective when Dr. Douglas from Washington explains to the men what is about to happen to them. His words are written for a university level audience and when he finishes speaking, there are no questions from his audience (the Boys) because no one in the room understood what he was talking about. It was left to Miss Evers to explain in the simple language of rural folks in 1932 Alabama what the doctor said. Had this not occurred they would not have understood what was happening. Later in the movie, Willie, the dancer, is convinced by both Dr. Rufus and Evers to allow them to give him a ‘back shot’ to treat the ‘bad blood’ or syphilis. The purpose is to hide their actions and what is being injected-essentially a simple saline solution. Each of these denies the subject the opportunity to make informed decisions affecting his or her health. In each of these cases the boys are coerced as well by Evers who tells them they have to do or they won’t get better. (Miss Evers Boys” 1997; Belmont; Williams et al: 435)

Another ethics breach in terms of informed consent occurs with the Caleb, her love interest. She tells them that the boys are not being treated with penicillin but that he is when he asks her if he has ‘it’. She confides that it is treatable but he alone is being treated. She further tells him not to disclose this to the others because there is no point in scaring them. He wants to know why he has a right to know about the treatment and they don’t? Her response is that she made an exception in his case. Clearly, the Belmont report makes it clear that were it in place in 1932, she would be in violation of it in that she not only failed to inform them of the risks associated with untreated syphilis but she withheld information from them necessary for them to decide if under the circumstances they would continue to go untreated.

The doctor later says that ‘we have to make them believe that nothing has changed. This is when Evers suggests they give them the saline solution in the back so they cannot see the difference in the color of the fluid in the needle.( Miss Evers Boys” 1997)

The senate committee in Washington in late 1972 in questioning Evers and a senator pointed out and acknowledged that Evers was following orders and was not subject to judicial proceedings. However, he asked her point blank, what in the world did she think she was doing by deceiving more than 400 black rural farmers from the south into thinking they were being treated for syphilis when for more than 40 years they were receiving saline solution as medical treatment? Her response was that ‘those men were susceptible to kindness and I gave them all that I had’. Of the more than 400 participants in the research, not one was treated with penicillin which would have made syphilis manageable. Those that were treated with the drug had been told for years they might day if they took it and when they were treated not one of them developed adverse effects as a result. Less than a third of the men survived and two of her boys had not succumbed-Willie the dancer and Caleb who had been treated with penicillin virtually from the beginning. (Miss Evers Boys” 1997)

References

U.S. Department of Health, Education, and Welfare, The National Commission for Protection of Human Subjects of Biomedical and Behavioral Research. (1979).The Belmont Report.  Retrieved November 9, 2010 from http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.htm

Home Box Office. Miss Evers Boys. (1997). Anasazi Productions. Williams, Robert; Willging, Cathleen; Quintero, Gilbert; Kalishman, Summers; Sussman, Andrew. Ethics of Health Research in Communities: Perspectives From the Southwestern United States.Ann Fam Med 2010;8:433-439.  doi:10.1370/afm.1138.