human research in the medical world.

This week we will explore chapter 6, looking at the topic of human research in the medical world. Many questions regarding the moral principle of justice are critical in this topic. You are to read case 2 on pages 255 – 256. As you read the case, look for key issues, think objectively, and consider the repercussions.

What are your thoughts about this case?
What moral principles are relevant to deciding what to do?

Instructions:

Your response to the question should be original, thoughtful, and reference the material (chapter one) to support your point.
Your response should be nothing less than a full paragraph (150 to 200 words).
In addition, you are to respond to at least one of your peer’s answers with a substantial reply. Engage their answer thoughtfully. Don’t just state that you agree/disagree, but articulate why.
Both your response to the question along with a response to a peer of your choosing

this is the  reading

1 – deadly results; shot to simulate battle wounds; frozen to death; starved to death; sterilized; and mutilated. The infamous Nazi doctor Josef Mengele liked to study twins: He had collected children from the camps, measured their physical features, performed crosstransfusions, transplanted genitals, and other organs, and even created artificial Siamese twins. He also used his twin collection for comparative studies, infecting one child and then killing both for autopsy.2 • In 1932 the U.S. Public Health Service began a 40-year experiment to study the damaging effects of untreated syphilis in human beings. The research, known as the Tuskegee Study, involved around 600 poor black men, about 400 of  whom had syphilis when they entered the experiment. The men were deceived about the nature of the study, were never told they had syphilis, and were never treated for it even when an effective treatment (penicillin) became readily available to the researchers. Several of the men died because of their untreated disease. • From 1944 to 1974, the U.S. government sponsored secret experiments to determine the effects of radiation on thousands of human subjects, including children. Some of the subjects were exposed to dangerously high doses of radiation, and many never consented to the research and were not told of the potential harm. • In 1956 researchers began a study of the natural course of hepatitis in institutionalized children, hoping to understand the disease better and to test a vaccine. Their experimental subjects were several hundred children housed at Two noble values help shape the vast, extraordinary enterprise known as medical science: knowledge and beneficence—the unceasing quest to know, to find out, and the aspiration to act for people’s good. When humans are the subjects of the research, these values assume their greatest importance, the stakes are at their highest, and the resulting ethical problems take on their sharpest edge. The chief difficulty is that these dual purposes do not fit together easily. Consequently, in its short history (dating from the early 1700s), systematized human research has engendered both great good and disturbing instances of evil. It has transformed our understanding of health and disease, magnified our power to treat and cure, saved millions of lives—and brought forth some astonishing moral outrages. To medical science we owe the development of vaccines against polio, smallpox, measles, rubella, yellow fever, and hepatitis; treatments for heart disease, diabetes, cancer, and AIDS; strategies to prevent heart attacks, deadly infections, and birth defects; and diagnostic technology ranging from stethoscopes to MRIs to genetic tests. But the search for knowledge through medical research has also led down some dark paths: • During World War II, Nazi physicians performed horrifying experiments on prisoners of war and civilians, killing and maiming many. At their 1947 trial in Nuremberg, Germany, the doctors were convicted of “murders, tortures, and other atrocities committed in the name of medical science.”1 Their unwilling victims were infected with cholera, smallpox, typhus, malaria, and other diseases; given poisons to evaluate the
2-  PART 2: MEDICAL PROFESSIONAL AND PATIENT Willowbrook State Hospital in New York, the state’s largest facility for retarded persons. In those days, conditions were such that most children admitted to Willowbrook eventually got hepatitis, which provoked flulike symptoms and immunity to future infections. For purposes of the experiment, the researchers infected the children with hepatitis when first admitted and monitored their bodies’ responses. They were later condemned for using children—especially retarded children—in their study and for the methods they used to obtain consent from the children’s parents. Such stories shocked both the public and the medical world and provoked a sustained wave of soul-searching among policymakers and scientists about the ethics of human research. Out of the trial of Nazi doctors came the Nuremberg Code (one of the readings in this chapter), a set of minimal ethical principles meant to govern all scientific experiments involving humans. Later came other professional codes and government guidelines that reiterated and added to the principles. These included the Declaration of Helsinki, embraced by the World Medical Association (WMA) in 1964 (also a chapter reading); the 1979 Belmont Report (another selection), formulated by the congressionally established National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research; and the 1993 international guidelines for biomedical human research, created by the World Health Organization (WHO) and the Council for International Organizations of Medical Sciences (CIOMS). Obviously the moral dilemmas inherent in human research can be intense and difficult. But in this age of ambitious scientific inquiry, they cannot be safely ignored. the science of clinical trials A scientific study designed to test a medical intervention in humans is known as a clinical trial. Normally the intervention is a drug or surgical procedure, and the point of the study is to determine the treatment’s effects in the human body—specifically, whether it is safe and effective. Properly conducted, clinical trials provide the strongest and most trustworthy evidence of a treatment’s impact on human health. Neither animal studies nor a physician’s informal observations are as reliable and convincing. Clinical trials can derive reliable answers because they are carefully configured to maximize objectivity, minimize bias, and avoid errors—all the problems that plague unscientific inquiries. A typical clinical trial devised to test the effectiveness of a treatment will consist of two groups of subjects: (1) an experimental group that gets the treatment to be evaluated and (2) a control group that closely resembles the experimental group but does not get the treatment. To learn anything useful about the treatment, researchers must study the relevant differences that arise between the two groups. Simply giving the treatment to the experimental group and observing what happens will not provide any useful answers. Usually, without a control group, the researchers cannot tell whether the subjects would have gotten better (or worse) without treatment, or if a factor other than the treatment was what most affected the subjects’ condition (such as changes in their diet or behavior), or if the subjects’ condition improved because of the placebo effect. (The placebo effect is a common phenomenon in which patients sometimes feel better after receiving treatment even when the treatment is inactive or fake.) With a control group, researchers can be more confident that relevant effects in the experimental group were brought about by the treatment and not by some extraneous element. The control groups in clinical trials that investigate efficacy are of two kinds. In a placebo control group, subjects receive a placebo, an inactive or sham treatment—a “sugar pill,” for example, or an inert pill that looks and tastes like the real drug. By using a placebo control group, researchers can take the placebo effect into account in assessing the worth of a treatment. For a treatment to be judged genuinely effective, subjects in the treatment group must