Progression of Bioethics in Medicine
The Impact of Human Experimentation on the Development of Bioethics in Medicine: Lessons and Limitations
Medicine’s utmost priority is to ensure the health of humanity, thus striving to improve diagnostic methods, treatment plans, and prevention strategies. Yet, the pursuit of these objectives has, oftentimes, crossed ethical boundaries that have led to horrific human experimentation. This raises an essential question: At what cost should humanity be sacrificed in the name of science? Bioethics, the field aimed at protecting patients’ rights amidst advancing technology, becomes necessary to setting foregrounds for the cross between humanity and science. To understand the cruciality of this dilemma the dark side of medicine must first be confronted, revealing human experimentation studies on uninformed groups forces mankind to explore the need for resolute standards in research.
The major turning point in medicine that produced bioethics is almost undeniably the Nazi human experimentation for medical research from 1942 to 1945. As medicine is often perceived as one-dimensional and for the ‘good of the people’, portraying the historical corruption of medicine is necessary for understanding the boundaries of research to underscore the significance of bioethics. However, people must be aware that there are exceptions to this ideology which include a dark chapter of the grotesque German nationalist movement that aimed for racial cleansing. Originally starting in 1933, it involved the work of willing German physicians who conducted numerous abominable experiments on inmates in various concentration camps. These experiments can be categorized into three sectors: survival of military personnel, drug and treatment testing, and advancement of Nazi racial ideologies (United States Holocaust Memorial Museum). The scale of the experiments is profound with 15,754 confirmed victims (Weindling), meaning it is likely that thousands of unaccounted victims were coerced to suffer in silence. Under the first sector, researchers studied transplants or to an extent human limb regeneration that caused “...excruciating pain, mutilation, and permanent disability as a result.” (Tyson), leaving no trace of scientific value. Drug and treatment testing included trials of sulfanilamide in which victims were inflicted battlefield-like wounds that were then aggravated with glass and wood shavings to intensify infections that were later treated with their drugs (Tyson). The final category, the advancement of Nazi racial ideologies, was used to justify “necessary discrimination against people with “undesirable” genetic characteristics—Jews, Roma people, LGBTQ people, people with disabilities and others.” (Blakemore) Defying a universal rule in science to hold no biases was shattered by the Nazi physicians as they used twins that had what they believed undesirable traits to delve into the realm of eugenics. When the world discovered these endeavors, twenty-three Nazi doctors were convicted, resulting in the Nuremberg code, setting a precedent for modern bioethics.
While the atrocities committed during the Nazi human experimentation were significant to defining bioethics with the Nuremberg code, they represent only a chapter of a tumultuous history of unethical medical practices. The evolution of bioethics has faced critical challenges, one of its most infamous being: the U.S. government's discreet studies of an uninformed population. The Tuskegee experiment, a notorious research on African Americans in Alabama for syphilis progression in 1932, is a landmark case for bioethics. About 600 African American males were deceived regarding receiving free medical treatment for syphilis and rather were given placebos (Human Experimentation). As the syphilis-infected men were given no effective treatment, many ended up dying, going blind or insane, or developing severe health complications (Nix). Thereafter, it was revealed in 2010 that a study in 1946-1948 in Guatemala of nearly 700 Guatemalans being unknowingly injected with syphilis by a U.S.-sponsored project that exposed their spouses and their children to the disease (Nix). As these communities fostered distrust toward public health, it was enlightening for the science community to address the ethical side of research and set down fundamental principles. These experiments have also exposed systemic racism as they tested on underprivileged groups and are the basis for the establishment of Institutional Review Boards (Moon). These abuses emphasize the urgent need for reform in medical research and to establish change in ethical standards. In addition, they highlight the importance of informed consent from subjects and reveal the deep-rooted social and ethical inequalities in medicine.
The precedents set from these experiments such as the Nuremberg code highlight the only justification for human experimentation to be if it benefits society and is aligned with ethical, moral, and legal concepts, featuring ten-point statements. Investigators pay Institutional Review Boards and therefore are subjected to influences by them. Although these are steps for protecting human rights, the code and boards are abstract and do not provide clear and steadfast regulations. The sixth point statement of the Nuremberg Code states, “The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment.” (The University of North Carolina at Chapel Hill). Objectively speaking, who can determine whether an experiment will produce more societal benefit than harm? And is there any way to measure the risks against the benefits? In the case of Nazi medical research, the physicians could argue that many of their experiments were conducted to treat soldiers from battlefield wounds which then creates the argument that some of their experiments can be “justified”. Moreover, morally speaking, one's views may influence how one perceives morals or ethics. Thus, in an environment such as Germany in the twentieth century, people are fostered in a community of extreme nationalism as “Hitler and other Nazi propagandists were highly successful in directing the population's anger and fear against the Jews; against the Marxists…; and against those the Nazis held responsible for signing both the armistice of November 1918 and the Versailles treaty, and for establishing the parliamentary republic.” (The Nazi Rise to Power). With an obscured moral compass, Nazi physicians can challenge the Nuremberg code and declare that according to their morals and German society, they stand corrected for their motives behind ‘racial cleansing.’ Consent is also prioritized in the code, though, it is arduous to authenticate consent as signatures can be forged, recordings may be manipulated, and so forth. In light of these considerations, it is apparent that although the Nuremberg Code and Institutional Review Boards set an important precedent for bioethics, there continues to be a subjective nature to determining societal benefit, malevolence of an experiment, and consent. The line between ethical experimentation and exploitation is thin which should compel the necessity for a global agreement on the balance between preserving human life in contrast to growing scientific knowledge.
Today, bioethics continues to hold significance with the rise of stem cells, and hybrid experiments between human and animal cells. Stem cells have been researched since the nineteenth century and were fully discovered in 1981 through mouse embryonic stem cells (Charitos). In 1998, biologist James Alexander Thomson discovered embryonic human stem cells that could become any type of cell (Charitos). The issue then becomes the destruction of embryos to obtain stem cells which has gained tension within the bounds of religion, ethics, and science with the question of when life begins — which even in the twenty-first century has remained in ambiguity. In 2019, Japan lifted restrictions on the creation of “chimeras” (human brain cells transplanted in an animal which is then placed into a uterus for further development) which in the U.S. has been restricted since 2015 (Raposo). Arising questions of whether these creatures should obtain legal status if they can gain the same if not similar conscientiousness of a human is underway and what terrors can this bring about to have another creature with such intellect as humans (Raposo)? The overarching conflict is how humanity is prioritized amid modern-day research. Medicine’s goal is to protect the life of humans not destroy it, though it seems that in the name of research the definition of “human life” has become subjectified under various pretenses and beliefs.
In conclusion, the development of bioethics is not static but rather faces ongoing challenges in the field that reflect the complexities of balancing advancing medical technology and the protection of human rights and life. Before proper guidelines were set, the journey toward establishing the field involved the pervert aspects of history such as the Nazi experiments and the U.S. government-conducted discreet studies on underprivileged groups. These obscenities, along with copious other unethical experiments, have laid down the foundation for a deeper understanding of the humanistic side of research more so than the scientific. As a result, bioethics evolved to address each critical issue that reinforces the need for transparency, accountability, and basic human respect in all medical research and practice. However, the question continues to remain: How can humanity be preserved in the face of thirsting science? Ethics are subjective; science is objective. Two opposing worlds collide to create what should be a phenomenal miracle to settle the grounds for humanity and the growing curiosity of science.
Written By: Sunny Han
Sources:
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