The Conflict Between Medical Research and Medical Ethics - Essay Example

Running head: Research & Ethics CONFLICT BETWEEN RESEARCH AND ETHICS The world, time and time again, is beset by esoteric and virulent viruses that threaten to exterminate man from the face of the earth. Thus, it is inevitable that human beings be the subject of experiments that would benefit mankind. But history is splattered with heinous tales of how these subjects of such tests are stripped of their dignity and human rights and even lost their lives in the process. Physicians who are obligated to respect human life under the Hippocratic Oath often forget their obligations. Thus, arise the conflict between medical research and ethics which is also intensified by violative acts of governments and pharmaceutical firms. These are countered though by the Nuremberg Code, the Declaration of Helsinki and the acts of the American and other medical associations. Introduction The world has been beset and besieged by various viruses and ailments that up to now remedies and cures are not yet available despite medical interventions and researches. While scientists have yet to find a cure for cancer and AIDS, mutated and virulent strains of viruses have cropped up to claim numerous lives while helpless governments watch in desperation as their citizens fall prey to these esoteric diseases. In 1918, Swine Flu made its ghastly entrance in Fort Riley, USA and immediately worked to wipe out half a million people. It reappeared in Russia in 1933 and in 1976 went back to USA to annihilate more people. Medical researchers frenetically worked to find an immunization remedy for this and vaccinated by government edict, some 40 million Americans. But to their horror, a new strain of disease was generated as a side effect which caused serious neurological disorders. This was named Guillain-Barre Syndrome and victimized 1098 people, 25 of whom died (Orr,2007,pp.21,23). Resulting to manifold lawsuits, this was one case where medical research floundered. Meantime, the swine flu made its presence felt again in Mexico in April 2009 and in a new mutated form which is called A(H1N1) and quickly spread to 30 countries infecting 12,515 people, 91 of which succumbed to death (Reuters, http://http://h1n1virus.us). In most of these cases, governments, in their desire to contain the disease, forcibly vaccinate those afflicted with the antiviral drug Tamiflu or Relenza which medical researchers had come up with to fight the mutated swine flu disease (Reuters, http://h1n1virus.us). Other virulent viruses that made medical researchers work against time to halt them before they bring down more people were the Asian Flu which originated in China in 1957 and killed some 70,000 Americans and 2 million people globally (Orr,2007,p.21); the Ebola Virus which internal and external hemorrhagic symptoms were truly frightening but which was contained only within Zaire and Sudan where it wiped out 400 people (Williams & Wilkins,2008,p.1010); the Avian flu in 1997; SARS in 2003(Friedlander,2009,pp.111-7) and HIV/AIDS virus, first identified in 1981 but which up to now continues to rage and has already killed 2.1 million people while infecting 33.2 million people worldwide (UNAIDS,WHO,2007). The Role of Modern Medical Research Hereinabove, it is clear that medical research has to be maximized in order to save lives from all these virulent strains of viruses that threaten to wipe out humanity from the face of the earth. Only the efforts of medical researchers can save humanity from a life-threatening devastation of the magnitude of bubonic plague which once wiped out of existence 1/3 of Europe or 25 million people from 1346-50 alone. The pioneering efforts of medical researchers to discover drugs such as streptomycin, gentamicin, tetracyclines and chloramphenicol in order to put to stoppage the havoc of devastation inflicted by The Black Death all over the world from 542 to 1950, was credited with putting to end that plague after it immolated 137 million lives. During that time medical ethics was put aside to halt the spread of the plague and benefit mankind. With the stench of death enveloping the atmosphere, people with or without their consent and without due consideration of their feelings or the pain they had to go through were hauled off to be bathed in human urine and splattered with human excrement and their abscesses incised and drained. This was because this was the treatment prescribed by the early doctors and was held to be necessary to benefit and save humanity (Tripod.http://hhtml.tripod.com) At that time no one stood up to question the unethical practices or their illegality. With today's viruses, people are also quarantined even against their will, forcibly hospitalized, vaccinated against their will, their body temperatures taken, their shoes asked to be taken out in airports and all sorts of acts that contravene their human rights and are clearly unethical. But laws consider them legal because they partake of the police powers of the state for the benefit of society and medical research dictated that these be the first line of defense against these diseases. The Conflict Between Medical Research and Medical Ethics The horrible swine flu treatment-experience in 1976 in USA where forcible immunization resulted to the appearance of the Guillain-Barre Syndrome, thereby killing 25 people, taught a lesson that intensive medical research in 5 stages be followed. In the discovery of new drugs, surgical techniques and medical devices, the first subjects of laboratory research are guinea pigs. The next stage requires that healthy human beings be tested for the right dosage, for possibility of detrimental side effects of the drug and for physiological reaction of the body to the drug. Then selected patients have to undergo drug treatment to find out whether the drug has the capability of treating their disease. The next stage which is randomized and controlled, requires that numerous patients be tested for the drug and a placebo or another drug. After the new drug is licensed and marketed, the research is elevated to monitoring stage called Post Marketing Surveillance Trial for the purpose of determining the absence of any long-term side effect to that drug and for any possible risks (Resta, resta.ee/id=10651.9k). It is in these 4 stages where human beings are experimented on, that conflicts between clinical research and ethics arise. In these stages, physicians and nurses are hired to conduct these researches. Under the Hippocratic Oath, it is the physician's obligation to "use his judgment to help the sick according to his ability and judgment, but never with the view to injury and wrongdoing" (Nemire & Kier,2002,p.16). But history repeatedly showed violations by physicians of their Hippocratic Oath the most glaring examples of which are the Nazi and the Russian gulag human experimentations. After World War II, the case of US v Karl Brandt in the Nuremberg Trials opened the world to the Nazi atrocities of human experimentation where 23 German doctors faced trial due to the deliberate infecting of Jewish prisoners with syphilis, malaria, typhus, cholera etc among others. These infecting experiments had the goal of testing various drugs. The German defence was centered on the need to sacrifice some human lives to save many other lives and insisted that other experiments conducted on humans including that of Nobel Prize winners shared the same nature of "ethically dubious experiments on human subjects" (McNeill,1993,p.22-3). These brutal, excruciating human experiments resulted to deaths of some 100,000 prisoners. Because the defence also included the fact that Americans were just as guilty of ethical contraventions in human experimentation as evidenced by a June 1945 Life Magazine article on US malaria experiment using 800 federal prisoners, it was evident that an international medical ethical standards be formulated. Also reminded of the shameful Tuskegee Syphilis study on 399 black men from Mason County, Alabama in 1932-1972 where the men were deceived and promised effective medical treatment for their syphilis where in reality there was no treatment at all and more horribly penicillin was withheld from them resulting to many of them going mad, blind and dead , the need for a medical ethics rules was strengthened (Beauchamp& Steinbeck,1999,p.20). Thus emerged from the case, the Nuremberg Code, which up to now remains as one potent medical ethics document. Among others, it declares that for experiments involving humans, it is essential that there be absolute voluntary consent of the human subject. Other provisions include " the necessity of prior animal experimentation, the elimination of any undue risk, and the right of the subject to terminate his or her involvement in the experiment at any time" (Galston & Peppard,2005,p.62). Despite the Nuremberg Code, physicians everywhere continue to violate their Hippocratic Oath in the guise of having to do a successful medical research which will benefit humanity. The conflict between medical research and medical ethics continue to strengthen unabated. And it goes on because physicians are also motivated by pressures from their governments, from the giant pharmaceutical companies which unsparingly compensate them, from lifestyle considerations, from career incentives that push them to opt for highly rewarding (in terms of monetary emoluments) subspecialty practice that wean them away from general practice, surgery and specialized medicine such as obstetrics or pediatrics. And titanic pharmaceutical companies and other medical corporations care least about medical ethics as their directions are focused on profits. Beside these never subscribe to the Hippocratic Oath. Governments don't bother about medical ethics because what is foremost in importance to them is the "common good". Thus, tampering with human genes such as in cloning, which have been branded by many as unethical, have been allowed by many governments and physicians go on using human beings for such medical researches. This human engineering work has lured many brilliant scientists such as Craig Venter, whose genome sequencing work had netted him a"net worth of more than $100 million in a few years"(Stock,2002,p.47). Scientists like him have grown deaf to criticisms of prostituting their talents by doing work that is highly unethical. In USA, unethical projects involving humans continued with the Willowbrook hepatitis experiments where severely retarded children were injected with hepatitis virus on the pretext that they were to receive vaccine for their hepatitis ailments. Then there was the case of Harold Blauer, a psychiatric patient who in a research on the effects of chemical warfare agents was injected with mescaline derivatives against his will and died as a result. Here the medical researchers duped him into believing it was for the treatment of his depression. Then again there was the injection of live, human cancer cells into non-cancer but debilitated patients of the Jewish Chronic Disease Hospital in 1963 where again the hoax was that it was for their well being. Then, the Cincinnati US radiation exposure experiments came where charity cancer patients were bombarded with large doses of hazardous radiation in a classified US military experiment against the will of the patients. But the worst arena where there is intensified conflict between medical research and medical ethics is in the treatment of prisoners. We have seen how the Jewish prisoners were converted into guinea pigs by the Nazis. As early as the 18th century, European medical researchers in order to study various diseases, "exposed prisoners to venereal diseases, cancers, typhoid fever and scarlet fever" without their consent (Kahn et al,1998,p.113). In USA big drug companies erect state-of-the-art prisons in exchange for the use of prisoners as guinea pigs for medical researches. In 1960, 20000 federal prisoners were made use of in research tests in USA in exchange for better prison conditions and terms and "American prisoners and prison-based facilities were also being used to test drugs for researchers abroad" (Kahn ert al,1998,p.114). Elsewhere in the world this pattern is repeated and in all cases physicians believe they were performing a licit duty and that the authorities are in the right frame of mind. They also not only failed to question authorities but also they lacked the guts to say no and cannot recognize the boundaries between what is their medical responsibility and what is medically unethical. To counter all these contraventions to medical ethics, the Declaration of Helsinki was formulated which among others, forbade the using of prisoners as subjects of medical research without their consent. Various associations concerned with medical ethics also banded together to identify acts violative to medical ethics and stress responsibilities not only by physicians but also managers of pharmaceutical and other medical companies who are enjoined to respect human rights and dignity of subjects of medical experimentations. These people in power are enjoined not to practice deceit but to be thoroughly honest and transparent in their dealings and to gain the consent of whomsoever will be selected to join medical research experiments and always be wary not to injure or harm them. This I believe is the ideal approach and is something I will also follow if I am placed in such position of power. Conclusion The use of humans as subjects of medical research experimentation cannot be avoided if we want the world to be rid of viruses and other maladies that threaten to exterminate man from the face of the earth. But it is often subject to abuse and physicians, in their desire to make the experiment a rousing success, often forget their obligations and responsibilities under the Hippocratic Oath. Governments and managers of pharmaceutical firms often prod these physicians to violate their medical obligations. Thus the world is shocked by many heinous acts in violation of the Hippocratic Oath such as the Nazi experiments using Jewish prisoners, he Tuskegee Syphilis study, the Cincinnati Radiation experiments among so many other tests. These contraventions to medical ethics were countered by the Nuremberg Code, the Declaration of Helsinki and the efforts of the American Medical Association and their counterparts in several parts of the world. These associations are watching intently that the hereinabove rules are followed by those behind these experimentations to practice respect of human rights and dignity of man and to be thoroughly transparent and honest in their dealings. BIBLIOGRAPHY Beauchamp,D.& Steinbeck, B.(1999). New ethics for public health.Oxford University Press US Friedlander, M. (2009). Outbreak. Twenty-First century Books. Galston, A.W. & Peppard, C. (2005). Expanding horizons in bioethics. Springer. Kahn, J., Mastroianni, A. & Sugarman, J. (1998). Beyond consent. Oxford University Press. Lippincott Williams& Wilkins. (2008). Professional Guide to Diseases. Wolters Kluwer Health McNeill, P.M. (1993). The ethics and politics of human experimentation. CUP Archive. Nemire,R. & Kier, K. (2002). Pharmacy clerkship manual. McGraw-Hill Professional. Orr, T. (2007). Avian flu. The Rosen Publishing Group. Reuters. (2009). H1N1 flu spreads to Taiwan, Kuwait, Iceland. http://h1n1virus.us. May25,2009 Resta. (2009). Stages of clinical research. Resta.ee/id=10651.9k. Reuters (2009). Could H1N1 start to resist drugs. http://h1n1virus.us. May 21,2009. Stock, G. (2002). Redesigning humans. Houghton Mifflin Harcourt. Tripod. (1998). Bubonic plague. http://hhtml.tripod.com. January 1998. Read More