Transcript Medical Ethics & Human Experimentation

Medical Ethics &
Human
Experimentation
Backdrop to this Class
 Many
aspects of medical ethics
 Patient-physician encounter
 Treatment
 Experimental subjects
 Limits to technology
 All
are 19th & 20th century
developments
 Previous
focus
ethical codes had different
 Hippocratic
Oath
– Legitimate practice of learned physicians
– Less mention of patients
 Do
no harm
 Maintain confidentiality
 Thomas
Percival: Medical Ethics
– Legimation strategy
 AMA
Code of Ethics (1847)
– Restore medical legitimacy
– Obligation of patient to physcian
– Obligation of physician to colleagues
 CMA
Code of Ethics (1867)
– Consolidate authority of regular
medicine
– Concerned about homeopathic medicine
 Other
reality was that patients were
not regularly exposed to
experimentation prior to 19th century
 Stagnation
of medical therapeutics
 Old
theories rejected, but not the
therapeutics that accompanied them
 Rejecting
old therapies tantamount
to admitting other medical sects
were more correct
 Some
experimentation had occurred
 Smallpox
 Jenner’s
inoculation: 1721
work with smallpox vaccine
– No evidence of consent
Hospitals as Sites of Medical
Experimentation
 Associated
with rise of the hospital
as site of medical treatment
 Bad reputation
 Confinement of infectious cases
 Fears of experimentation by
unscrupulous physicians
 Autopsy
used to improve diagnostic
accuracy
 Feared by lay people
 Associated with dissection
 Primarily
a preoccupation of the
poorer classes
Rise of the Medical Laboratory
 First emerged
19th century
 Helped
in France in last half of
physicians understand how
diseases worked
 Advanced medical therapeutics
Claude Bernard
(1813-1878)
 Believed the lab
was the future of
medicine
 “It is what we think
we know already
that prevents us
from learning”

 Discovered
glycogenic function of the
liver
 Pasteur built upon the reputation of
the lab as the new locus of medical
knowledge
 Medical scientist replaced medical
clinician as the new model of medical
progress
Animal Experimentation
 Much
knowledge was gained from
vivi-section
 Used cats & dogs as experimental
subjects
 Ways of procuring research animals
sometimes dubious
 Opposition mounted
 SPCA
formed in Britain in 1824
 Became RSPCA in 1840
 Began to oppose vivi-section after
development of anaesthesia in 1850s
 Believed animals should be
aneasthetized, then euthanized
 Opposed use of cats, dogs, horses
 1874
Royal Commission
 Lobby group set up led by Frances
Power-Cobbe
 Had considerable popular support
– eg: George Bernard Shaw
 Cobbe
continued to lobby for
abolition of animal experimentation
Frances PowerCobbe (18221904)
 Wide-ranging
interests in
feminism, social
justice, animal
rights

 Anti-vivisectionists
had complex
reasons for opposition to use of
animals
– Cruelty
– Feared it would blunt sensibilities of
young physicians
– Opened door to human experimentation
 Another
Royal Commission in 1st
decade of 20th century
Human Experimentation
 Also
problematic
 19th century standards were quire
different
James Marion Sims
(1813-1883)
 Celebrated as the
“founder of modern
gynecology”
 Practiced in
Montgomery,
Alabama

 Developed
a new surgical procedure
to repair vaginal fistulas
 Result of long series of experiments
on black slaves
 Did surgery without anaesthesia
 Alleged that many women died
during his experiments
 Sims’s
day
 Similar
legacy controversial to this
problem with Pasteur’s work
with rabies vaccine
Medical Ethics in the 20th Century
 Anti-vivisection
movement raised
consciousness of medical profession
 Also aware animal models couldn’t
always work
 Created set of rough guidelines for
human experimentation
 Must
first, if possible, be tested on
animals
 Physician willing to experiment on
self or family member
– Not always possible
 Patient
demonstrate willingness to
submit to experiment
– Often signified by payment
 Max
von Pettenkoffer opposed Koch’s
germ theory of cholera
 Swallowed a sample of cholera bacilli
 He lived
Yellow fever
experiments
 As early as 1807, it
had been
suspected that
mosquitoes might
be vectors
 Experimental work
by Carlos Finlay
(1833-1915) of
Cuba in 1870s

 Published
paper in 1881
 Hypothesized that it was mosquito
borne
 Unable to experimentally
demonstrate the link
 Spanish-American
war (1898)
 Appalling mortality in American
troops
Walter Reed (18511902)
 Arrived in Havana
after the war to
investigate
outbreaks of
typhoid fever
 Moved on to yellow
fever

 Two
arms to the research
– Disprove miasma theory
– Prove mosquito theory
 No
animal models for the disease
existed
 Forced to use human volunteers
 Initial
experiments conducted on 2
members of the commission
 Both contracted disease; one died
 Tests on more volunteers
– Used written consent
– Paid participants
 $100
for participating
 $100 more if contracted disease
 Payment
problematic
 Changes motivation for volunteering
 Documentation that some volunteers
cried when they were not selected
 Other
late 19th & early 20th century
human experiments did not even
attain this level of consent
 1891
Swedish experiments on
smallpox
 Used children recruited from an
orphanage
 Cheaper than calves
 No
government regulation of human
experimentation
 Britain had legislation re: animal
experimentation
 US had neither
 Resulted in experiments we would
deem unethical today
 Experiment
in US leper colony
 Test hypothesis that leprosy &
syphilis were same disease
 6 girls with leprosy inoculated with
syphilis
 Did not develop disease
 Subsequently 12 more children
inoculated
 Drug
toxicity tests on mental
patients
 8 patients given increased doses and
responses documented
 Justification: all were past the point
of recovery from their illness
 Experiment
in Boston
 Test diagnostic utility of lumbar
puncture
 45 children at or near death
underwent procedure
 Congressional
hearings on human
experimentation in 1916
 No
bill passed
 AMA refused to amend Code of
Ethics
 Support for anti-vivisectionism &
human experimentation waned
 Public more interested in successes
gained by these techniques
 1922
discovery of insulin
 Anxiety
about human
experimentation did not re-emerge
until after Second World War
 Nuremburg
Code (1947)
 AMA
adopted principle of informed
consent in 1946
 Problems
with ethical human
experimentation continued
 Tuskegee
1972)
syphilis experiment (1932-
 Lobotomy
 Compulsory
sterilization
 What
can we learn from these
examples?