Ethics and Infectious Diseases
Throughout history the human race has struggled with what is and is not ethical, especially when it comes to medical and social practices among society. Sense the first epidemic in history, many of these unethical practices have been associated with the outbreaks of different infectious diseases. Unethical practices do to infectious diseases date back over 1,000 years. An example of this occurs in 541 A.D., with the Plague of Justinian.
In 541 A.D. people had not yet realized the diseases were spread by microscopic organisms. Instead, People thought the plague was a punishment from God for humanity being bad. Procopius, a famous scientist and author in the Byzantine Empire at the time, laid the blame for the outbreak on Justinian, the emperor, stating that Justinian was either a devil, or God was punishing him for his evil ways. (Horgan, 2014) This trend only worsened throughout history. During the years of the Black Plague, society decided to put the blame on two groups of people; prostitutes, and people doing what they considered unholy, and Jewish people. Similar to the idea society had in 541 A.D., people thought that the black plague was another punishment from God. Biases against certain groups of people continued throughout history with different pandemics and epidemics. These biases have caused many social uprisings, and even massacres among certain groups of people. Although there are not many examples in recent history of people blaming God’s anger on a certain group of people for a disease, there are still examples of biases and social stigmas put on people who contract certain diseases. A common example of this is the current social stigma connected with contracting AIDS and HIV. AIDS and HIV commonly come with a stigma of “homosexuality, drug use, poverty, migration, transgender status, mental illness, sex work, and racial or ethnic tribal minority status” (DeCarlo and Ekstrand, 2016).
Another ethical dilemma that comes into play with the onset of different infectious dieses is isolation and quarantine. The Practice of quarantine began in the 14th century in an attempt to protect costal cities from spreading the Black Plague during the Black Plague pandemic. Ships arriving in Venice were required to sit outside of the docks, on an anchor, for 40 days before docking. (Center for Disease Control, 2014) Cordon Sanitaires were also created in the 14th century in an attempt to control the Black Plague. Cordon Sanitaires were literally rings of armed soldiers who were ordered to guard against diseased people. People infected with the Black Plague were locked in their homes, with uninfected members of their family. Neither infected nor uninfected people were aloud to leave their homes, which in the end lead to higher mortality, because these uninfected people would then become infected with the Black Plague. (Sherman, 2017)
One of the more recent ethical dilemmas when it comes to infectious diseases involves experimental studies on humans. One of the most famous unethical experimental studies done on humans was the Tuskegee Syphilis Study. The Tuskegee Syphilis Study was a study done on poor African American men in Macon County Alabama. Macon County was an extremely poor County consisting of an 80% African American population. Only living 2 or 3 generations from slavery, many of them still worked on plantations for white men. The people of Macon County were already oppressed by bad healthcare, and they were already struggling with high rates of syphilis. In the early to mid 1900s, when the study took place, it was thought that white and black people were affected differently by syphilis. The study began when a doctor by the name of Taliaferro Clark decided that Macon County would be perfect for a 6-month study on the effects of untreated syphilis in African American men. Not only did Taliaferro Clark believe that syphilis affected the African American community differently then the rest of the population, but he also believed that syphilis was not fatal in African Americans. Clark and his men looked for African American men in Macon County churches and school systems, and told them that this experimental study would give them access to free medicine and free doctors. The citizens were told that they had “bad blood” and that by doing this study they would be treated for that. People were never told the true nature of their illness, or what was actually going on in the study. One of the most disturbing parts about this is only a century ago our government authorized this experiment, Taxes from American citizens paid for this experiment, and American doctors carried out this experiment. By the end of the six months a doctor named Raymond Vonderlehr felt as though they were finding too much information. The doctors decided to continue on with the study in order to increase their findings. Eventually, it was decided that the Tuskegee Syphilis Study would be an ongoing study, and that the doctors would continue the study all the way to the point of autopsying the patients. Patients were bribed with 30 to 50 dollars of life insurance, and a proper burial if they were to die. A nurse named Eunice Rivers was hired to gather participants when the doctors came to town, find controls for the experiment, help the patients with minor problems, and observe the patients while the doctors were gone. Even after the Nuremburg trials, which created laws against unethical medical procedures on humans, the men were still not informed, and the study continued. Men were also denied Penicillin when Penicillin was discovered, out of fear that treating the patients would ruin the study. (“The Deadly Deception”, 2014) After 40 years, 74 of the 399 test subjects were alive, 28 had died of syphilis, 100 had died of other related complications, 40 of the wives had been infected, and 19 of their children were born with congenital syphilis. (Althaus)
Another unethical Syphilis experiment was done in Guatemala from 1946 to 1948. This studies intent was to study different medications effects on preventing symptom emergence of certain sexually transmitted diseases. The study included more then 5,500 Guatemalan prisoners, sex workers, soldiers, children, and psychiatric patients. Disturbingly, about one-quarter of them were deliberately infected with syphilis, gonorrhea, or chancroid. They were also all enrolled in these experiments without consent. (Rogers, 2018)
Medical ethics is still, and most likely always will be, an issue throughout the world. There are many potential consequences however involved in carrying out unethical practices, that can last much longer then many people may realize. One major issue with carrying out unethical practices is the loss of trust between doctors and patients. Without trust in doctors, many people will refuse to go to the hospital out of fear, which could lead to the spread of different diseases, as well as negative medical effects on the person refusing medical help. This could also lead to an unwillingness of people to participate in medical studies that are ethical, and could help people in the long run. In the end, trust within the government, as well as the medical community, is needed in order for society to stay in order. Without trust society, will be afraid to listen to what the professionals have to say.
References
Althaus, Janyne. “Medical Ethics.” Hopkinsmedicine.org , John Hopkins School of Medicine,www.hopkinsmedicine.org/gynecology_obstetrics/pdfs/medstude nt/rtc2014/8-414%20Bench%20to%20Bedside%20Ethics%20Lx.pdf.
DeCarlo, Pamela, and Maria Ekstrand. “Stigma (Fact sheet).” UCSF Center for AIDS Prevention Studies, 16 Aug. 2017, prevention.ucsf.edu/library/stigma/.
“History of Quarantine.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 31 July 2014, www.cdc.gov/quarantine/historyquarantine.html.
“Office of History, National Institutes of Health – Timeline of Laws Related to the Protection of Human Subjects.” National Institutes of Health, U.S. Department of Health and Human Services, history.nih.gov/about/timelines_laws_human.html.
Rogers, Kara. “Guatemala syphilis experiment.” Encyclopædia Britannica, Encyclopædia Britannica, inc., 19 Apr. 2017, www.britannica.com/event/Guatemala-syphilis-experiment.
Sherman, Irwin W. The power of plagues. ASM Press, 2017.
“The Deadly Deception.” YouTube, YouTube, 5 Nov. 2014, www.youtube.com/watch?v=qNa8CnC4sSU.