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Abstract
The Tuskegee Study conducted in the 1932-1972 period provoked significant controversy concerning ethicality and morale of conduct. The physicians involved in the experiment failed to inform their participants about the essence of the experiment and its possible outcomes. As a result of the case, the matter of informed consent has been put forward, as a means of protecting patients’ welfare. The importance of informed consent in nursing research is indispensable to ensure adherence to existing ethical and legal standards.
Introduction
In 1932, the U.S. Public Health Service initiated a clinical study in Tuskegee to examine the natural development of untreated syphilis among impoverished black men who did not even suspect the experiment. The case had provoked controversial feedback among the nursing professionals and gave rise to the consideration of ethical standards. Reconsideration of the tragic consequences of the Tuskegee study put forward moral and ethical dilemmas and required the introduction of informed consent as an obligatory condition for clinical studies.
Overview of the Case
The participants were informed that they were given free medicine to treat them for “bad blood”. The doctors never told their patients about the actual purpose of the study. As the result of the study, about 200 people died of syphilis and about 40 wives of the participants were infected. 19 children were delivered infected with congenital syphilis (Reverby, 2009). The illegal issues and ethical concerns presented in the case were largely explained by insufficient education and health infrastructure that supported demonstration work. Because no public hospital existed, the information about the experiment was concealed and few people could access it.
Because people experienced significant problems with health insurance and living conditions, they agreed to take part in the clinical study, although they were not aware of the consequences and initial purposes of the research. Besides, the doctors took advantage of the situation and persuaded the poor, black people that they received treatment and free meals as a part of health care reform. The study, therefore, provided serious problems in gaining consent from the individuals engaged in the study. In this respect, “Tuskegee…was seen as a problem of lack of consent rather than within a broader context of justice tied to the everyday experiences of African Americans with medical care” (Reverby, 2009, p. 194). Therefore, no connection between race and treatment could be outlined in the case on the one hand. On the other hand, the actual choice of the participant is directly related to the race issue.
History of Informed Consent
Historically, the absence of consent to treatment permitted the patients to file a lawsuit against health professionals. Lack of informed consent is regarded as the battery, and unlawful touching of another (Killon and Dempski, 2006). Today, informed consent is considered a part of ethical and legal standards of conduct, the violation of which can become the basis for liability.
Main Elements of Informed Consent
Description of the Procedure
A patient can give informed consent provided three basic requirements are met. To begin with, a health care professional should inform the patients about possible threats and benefits of medical treatment, as well as threats and benefits a patient may face in case of refusal. The doctors should also warn their patients about successful outcomes, alternative treatments, and the credentials of the ones involved in the procedure (Killon and Dempski, 2006). Second, while giving informed consent, a patient needs to be under no external influence. Nurses should be accountable for controlling medications before the procedure. They should also ensure that consent is given before medicating (Killon and Dempski, 2006). Finally, the competence of the patient is another important condition under which a patient gives informed consent. Patients’ competence lies in their ability to “communicate choices, understand relevant information concerning treatment, and appreciate the situation as it applied to them” (Killon and Dempski, 2006, p. 43). The entire process should be under the strict control of nurses who take responsibility for the patient’s attention.
Limitations to Informed Consent
The Tuskegee study proves that neither of the elements had been involved in the procedures, which led to lethal outcomes. Therefore, the health care department must take control of the moral and ethical concerns, which should be a priority in clinical experiments and research. Ethics in research, particularly the case with informed consent, has several limitations. In particular, it is suggested, “the best-informed consent covers an emergency without being overly broad and thus not valid” (Killon and Dempski, 2006, p. 44). Therefore, although informed consent is limited, all possible contingencies should be taken into consideration.
Conclusion
The matter of informed consent is on the current agenda in health care. Nurses and physicians should take responsibility for the medical procedures and inform their patients about the purposes, contingencies, benefits, and possible risks of the proposed treatment. Alternatively, the patients who have not been properly informed have the right to sue for the battery. Professional health care should be subject to existing ethical and moral codes of conduct to avoid the potential dangers to patients. The Tuskegee case is a bright example of the consequences of failure to inform the participants about the purpose and outcomes of the experiment.
References
Killon, S. W., & Dempski, K. (2006). Quick Look Nursing: Legal and Ethical Issues. US: Jones & Bartlett Learning.
Reverby, S. (2009). Examining Tuskegee: The Infamous Syphilis Study and Its Legacy. US: University of North Carolina Press.
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