Ethics of Prisoner Experiments Prisoner Experiments Prior

Ethics of Prisoner Experiments Prisoner Experiments Prior to the medical trial at Nuremberg physicians and scientists were largely free to conduct experiments on unsuspecting persons (Freyhofer, 2004, p. 9-10), including inmates inside America's prisons. When it was discovered that German physicians had been conducting inhumane experiments on death camp and concentration camp prisoners during WWII, the world was shocked that doctors were capable of such behavior.

The American Military Tribunal in Nuremberg heard arguments from both the defense and prosecution for twenty three doctors and administrators accused of war crimes and crimes against humanity. The defense argued that the doctors' conduct was not a significant departure from past practices and any inhumanity was more a function of the ongoing hostilities. The judges on the tribunal saw it differently and created ethical guidelines for medical researchers, because the evidence presented in court revealed the Hippocratic Oath could not protect patients and prisoners from harm.

These ethical principles became known as the Nuremberg Code. Just one of the many inhumane experiments conducted by the Nazi doctors involved close to 200 prisoners being held at the Dachau death camp (Freyhofer, 2004, p. 27). In order to better understand the risks faced by pilots bailing out at high altitude, prisoners were placed into hypobaric chambers at low atmospheric pressure and then the pressure increased rapidly. Between seventy and eighty prisoners died during these experiments because of brain embolisms.

The cause of death was determined by submerging prisoners in water and watching for air bubbles while dissecting the bodies; however, the cardiograms often indicated that the hearts were still beating during the dissection. The Nuremberg Code was a response to such experiments. The first principle in the Code requires all subject participating in a study to do so voluntarily (HHS, 2005). To meet this guideline the subject cannot be coerced to participate in any way and must understand what will occur to them during the experiment (informed consent).

The second principle requires the research to potentially benefit society in a meaningful way and that the experiments could not be performed without human subjects. There are several more guidelines in the Code, but these two represent the most basic ethical principles of subject autonomy and beneficence. Both were violated by the Nazi doctors because prisoners in concentration and death camps cannot be reasonably be viewed as having any autonomy. The Nazi doctors also violated the second principle, because they probably could have used animals instead.

The above discussion highlights the unique status of prisoners within human experimentation, because under most circumstances they lack autonomy. The Holmesburg State Prison in Pennsylvania had become a hotbed of human experimentation from the early 1950s to the mid-70s, in spite of the Nuremberg Code (Hornblum, 1998, p. 3-6). The U.S. Army wanted to test chemicals on human skin and researchers at the University of Pennsylvania were willing to help.

One of the case examples provided by Allen Hornblum in his book Acres of Skin describes what an intelligent inmate faced when given the chance to participate. In 1964, prisoners were earning about 15 cents a day working in prison shops, but a prisoner could earn anywhere from $50 to $500 per month as a human guinea pig for the U.S. Army. Within the prison's economic system, earnings like those were coercive and therefore violated the Nuremberg Code.

Several of the defendants at the Nuremberg Medical Trial cited the numerous experiments conducted by American doctors and scientists in American prisons before the tribunal of American judges (Hornblum, 1998, p. 75-80). American prisoners were being routinely maimed, tortured, and killed in the name of medical science in the years leading up to WWII. American policymakers and researchers at the time believed that bettering society at the expense of prisoners was a noble cause and the Nuremberg Code did little to slow their efforts.

By 1978 the federal government finally instituted a ban on prisoner research because of the belief that prisoners cannot voluntarily give informed consent (Lerner, 2007). The Institute of Medicine (IOM) however, has recently published a report that seems to end the ban under certain conditions. The IOM policy position is based on the belief that prisoners have a right to participate in medical research, especially those who could benefit directly from research findings.

Accordingly, prisoners infected with HIV (human immunodeficiency virus) should be allowed to participate in studies investigating treatments and cures for HIV and AIDS (acquired immunodeficiency syndrome) because they could benefit directly from such research. Barron Lerner (2007) argues that the IOM policy statement does not return prisoner research to the bad old days of Holmesburg Prison experiments, when prisoners were treated as objects serving science and the only benefits received were a big paycheck.

The IOM policy instead opens a door for prisoners to engage in research studies under informed consent and only when they would benefit medically. This policy would have discouraged the Holmesburg prisoner research studies and the more infamous 40-year study investigating the natural progression of syphilis in poor Southern African-American males at the Tuskegee Institute in Alabama.

The Tuskegee experiment was viewed in such a bad light that it directly contributed to the formation of the National Commission for the Protection of Human Subjects and its policy of personal autonomy, nonmaleficence, and justice in human subject studies. The U.S. Department of Health and Human Services finally recognized that prisons were inherently coercive and therefore prisoners represented a vulnerable population (Lerner, 2007). Any rewards, including monetary, were inherently exploitative. The IOM does deserve some credit for initially recommending that this policy position remain in place.

This recommendation was based on the fact that the prison system had grown to house a record 2.3 million Americans (Pew Center on the States, 2009) and a disproportionate number of society's most vulnerable demographics, including minorities and the mentally ill (Lerner, 2007). A number of safeguards were recommended by the IOM, including informed consent, the creation of a database to track experiments, and the requirement that prisoners involved in the studies could potentially benefit medically from the results.

Conducting experiments on HIV-infected prisoners for the purpose of developing more effective treatments, cures, or vaccines would fit well within these guidelines. Conclusions The prison population in the U.S. has exploded since the 1970s.