This is the most controversial post I have ever written in ten years of blogging. I wrote it because I was very angry at a specific incident.
Standler's draft code Improvements in medicine and surgery during the last two centuries have greatly extended the average lifetime of people and reduced the pain and disability following various injuries and diseases.
Because medicine and surgery have a strong basis in scientific knowledge, it is absolutely necessary for medical progress that there be experiments on humans. There can be no doubt that human experimentation is necessary and desirable. Society owes a great debt to the many creative physicians and surgeons who have performed ethical experiments and advanced medical technology.
If there be any doubt, I say that I am definitely in favor of research, but we should also insist on ethical conduct. There is also a dark side to human experimentation: Not only was informed consent not obtained, but the physician often fraudulently described the experimental procedure as either a diagnostic procedure or a treatment for the patient's condition, when the physician had no reason to believe that the patient might benefit from the experiment.
History has shown that nonconsensual experiments are often performed on captive people in an institution, particularly people who society has regarded as "less worthy" e. Such people are unable to decline or reject the experiment and few people will ever know what really happened.
Regulation of medical experimentation on human beings must consider the following: Experiments on human subjects are performed after in vitro experiments and after experiments on animals have shown that a drug or technique has a reasonable possibility of benefiting human beings.
In assessing the desirability and acceptability of the experiment, one should consider the severity of the disorder e. Informed consent is necessary for the personal autonomy of the subject. In my opinion, these three considerations are not to be balanced against each other, but are to be independently satisfied.
The conflict of interest is worth exploring further, as it is the key to analyzing much of the ethics of human experimentation. Patients expect safe, effective treatment for their condition and patients trust their physician to supply unbiased advice. But, in human experimentation, the relationship is often not physician to patient, but is researcher to subject.
The researcher gets paid to do the clinical trial or experiment, and may also receive royalty income from new drugs, devices, or cell cultures that are developed in the experiment.
The researcher may even become famous as the author of a landmark paper in the archival medical literature, which is a kind of immortality. In contrast, the subjects get pain and sometimes permanent injury, or even death, from the experiment. A copy of the Nurnberg Code is posted at the U.
Absolutely essential to obtain voluntary, informed consent of every human subject.
Voluntary means without any element of force, fraud, deceit, duress, or coercion. Experiment must be designed to yield results for the good of society, unprocurable by other means of study.
Animal experimentation should precede experiments on humans. Must avoid all unnecessary physical and mental suffering and injury.
Do not perform experiments in which there is reason to believe death or disabling injury will occur. The degree of risk taken by subjects should never exceed that determined by the humanitarian importance of the problem to be solved by experiment.
How do we apply this vague, overbroad principle? Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death.
The experiment should be conducted only by scientifically qualified persons. Human subject may withdraw consent at any time if he has reached the physical or mental state where continuation of the experiment seems to him to be impossible.
Scientist must terminate experiment at any time, if he has probable cause to believe that continuation of experiment is likely to result in injury, disability, or death to the experimental subject.
This code also appears to prohibit innovative treatments on dying patients. Results of such experiments could be useful to save lives of innocent people. It is not realistic for the physicians to be both subjects and also monitoring their condition.
Furthermore, weasel words like "except, perhaps" have no place in a code of conduct. I conclude that this Code is only a first draft, and not a particularly good one. Society has no problem with asking military personnel to die for their country, why can't society tolerate people dying during medical research?
People voluntarily engage in risky recreational activities, why can't they consent to potentially hazardous medical experiments? Various codes of ethics for physicians have been posted by the Center for the Study of Ethics in the Professions at Illinois Institute of Technology.
Notice that informed consent for medical experiment is different from consent to diagnostic and therapeutic procedures during regular health care. Before a medical experiment, the risks must always be disclosed to the subject, whereas there is often a therapeutic privilege to withhold full disclosure during regular health care.
Joseph Fletcher, in Experiments on Humans presented to the World Health Organization in Marchlists the following 15 factors to consider:Online Subscription. Unlock this article, and thousands more from our complete 55+ year archive, by subscribing at the low introductory rate of just $1 an issue – that’s 10 issues online plus six months of full archive access for just $ The Online Writing Lab (OWL) at Purdue University houses writing resources and instructional material, and we provide these as a free service of the Writing Lab at Purdue.
The Indiana University School of Medicine Division of Continuing Medical Education is a large and robust provider of CME with activities ranging from large multi-day conferences to online modules.
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May (This essay is derived from a guest lecture at Harvard, which incorporated an earlier talk at Northeastern.) When I finished grad school in computer science I went to art school to study painting.