Transcript The Syphilis Experiment and the Tuskegee Airmen

The Syphilis Experiment
Alyssa Emanuelson, MS, MAT, ATC
Tuskegee Study of Untreated
Syphilis in the Negro Male
• Study started in 1932 @ Tuskegee Institute
with the Public Health Service
– Record the natural hx of syphilis
– Hoped to justify treatment programs for
blacks
• Participants
– Initially black men
• 399 had syphilis
• 201 didn’t have syphilis
Purpose of Study
• Determine the natural course of untreated
latent syphilis
• The study was meant to discover how syphilis
affected blacks as opposed to whites—the
theory being that whites experienced more
neurological complications from syphilis,
whereas blacks were more susceptible to
cardiovascular damage. How this knowledge
would have changed clinical treatment of
syphilis is uncertain.
Ethical Issues of this Study
1) No Informed Consent
2) Not informed of all known dangers
3) Participants had to agree to autopsy after
death to have burial paid for
4) Scientists denied treatment to some patients
in order to observe the individual dangers
and fatal progression of the disease
5) Participants not given a cure, even when
widely known and easily available
6) Misleading advertisement—subjects not
given treatment—they were recruited for a
very risky spinal tap-diagnostic
Informed Consent
• Conducted without the benefit of informed
consent
• Men were being treated for “bad blood”
– Ailments including syphilis, anemia, and fatigue
• Didn’t receive proper care to cure illness
• In exchange:
– Free Medical Exams
– Free Meals
– Burial Insurance
• Projected to last 6 months—it lasted 40+ years
Informed Consent Continued
• Not informed about the whole purpose of
the research
• Not informed of dangers of study
• Experiment was considered as beneficial
for humankind
– Human Guinea Pigs
Human Guinea Pigs
• Nature of study kept quiet to ensure
compliance
• Grossly disadvantaged lifestyle made them
easy to manipulate
• Pleased by prospect of “free” healthcare
– Many had never seen a doctor before
• Last chance for “free medical care”
– Lured men to dangerous spinal taps
Syphilis
• Bacterial
• Direct contact through oral, anal, and
vaginal sex
• Pregnant women can pass it on to babies
• S/S
– Sores from where entered body
– Rashes in secondary stage
• Latent stage
– Damage internal organs
• Treat with Penicillin
Data from study
Data for the experiment was to be
collected from autopsies of the men, and
they were thus deliberately left to
degenerate under the ravages of tertiary
syphilis—which can include tumors, heart
disease, paralysis, blindness, insanity, and
death. “As I see it,” one of the doctors
involved explained, “we have no further
interest in these patients until they die.”
Penicillin
• By 1947 Penicillin had become standard
treatment to cure syphilis
• Instead of closing the study and giving the
cure, the scientists withheld treatment
from participants
Treatment
• Treatment of time
– bismuth, neoarsphenamine, and mercury but
only 3% survive with those
– Token treatment = good PR but didn’t really
do anything
End of Study
• Study ended in 1972 after the AP exposed
the study in a series of articles
– More than 25 years after the known cure
• Consequences of study
– 28 people died from syphilis
– 100 died from related diseases
– 40 wives and 19 children infected with
syphilis
Basic Principles Required to follow
today…
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Autonomy
Veracity
Beneficence
Non-malficence
Confidentiality
Justice
Fidelity
Code of Ethics
Scope of Practice
Patient’s Rights
Activity
• Scavenger hunt!
– With your SLP group, you are to use one of the
“babies” to look up the term listed on the screen
and give me an example of it that makes sense.
The first group to do so wins a point the team with
the most points wins
Patient Autonomy
• What is?
• Why is it important?
• Example…
Patient Autonomy
• Autonomy: right of patients to make decisions
about their medical care
– Medical Provider can’t influence decision
– Medical provider must educate pt. but can’t make
decision for pt.
Veracity
• What is it?
• Why is it important?
• Example…
Veracity
• The ethics of telling the truth
• Accountable for what they tell the patient
• White lies not okay…
Beneficence
• What is it?
• Why is it important
• Example…
Beneficence
• Action that is done for the benefit of others.
Beneficent actions can be taken to help
prevent or remove harms or to simply
improve the situation of others.
• Doctors must refrain from harming pts.
• Weigh benefits vs. risks of treatment (big issue
in Miss Evers’ Boys)
Non-Malficience
• What is it?
• Why is it important?
• Example…
Non-Malficience
• Do no harm.
• Physicians must refrain from providing
ineffective treatments
• Not acting with malice toward patients.
• Some beneficial treatments may also have
inherent risks
Confidentiality
• What is it?
• Why is it important?
• Example…
Confidentiality
• Duty to keep patient’s confidence
• Full and frank disclosure from pt. to MD—so
that diagnosis can occur
• Shouldn’t reveal what was said (with
exception to when pt. threatens bodily harm
to self/others)
Justice
• What is it?
• Why is it important?
• Example…
Justice
• Fair distribution of health care resources
• Elimination of discrimination, whether based
on race, gender, age, socioeconomic status,
ethnicity, religion, or any other social category
Fidelity
• What is it?
• Why is it important?
• Example…
Fidelity
• Patients’ interests first in mind above all
others
• Maintenance of patient trust and confidences
• Obligates them to carry out their promises to
care for patients with faithful attention
Code of Ethics
• What is it?
• Why is it important?
• Example
Code of Ethics
• Competent medical care
– Dignity and compassion
• Professionalism
• Respect the law
• Continue to study, apply, and practice knowledge
relevant to the field
• Respect the rights of patients, families, and colleagues
– Confidentiality
• Access to medical care for all
• Patient needs before personal preferences
• Aid in and better the community
Scope of Practice
• What is it?
• Why is it important?
• Example…
Scope of Practice
• Used by national and state/provincial licensing
boards for various professions that defines
– procedures, actions, and processes that are
permitted for the licensed individual.
• What you are allowed to do as a professional
– Nurse vs. Doctor
– Athletic Trainer vs. Physical Therapist
Patient’s Rights
• What is a patient’s rights?
• Why are they important?
• Example…
Patient’s Rights
• Right to access of easily understandable health
information
• Right to choice of providers
• Access to emergency service
• Taking part in treatment decision
• Respect and non-discrimination
• Confidentiality
• Complaints and appeals processed fairly and in a
timely manner
Assignments
• ICC Terms Assignment
• Reaction Paper