Segregation of Bioethics in Medical Research

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Introduction

The human need to advance and create a quintessential life is an overwhelming desire that engulfs aspiring individuals and leads them to abandon something crucial to life and society, ethics. For medical researchers, advancement is defined by exploring the human body to its entirety and discovering cures for illnesses. Essentially, the ideal dream would be to decrease the mortality rate in the human species and to eliminate diseases. (Baker, 2017). For this, medical researchers require human and animal subjects to test their theories and to make discoveries upon. (Maczulak, 2011)

During the Nazi regime, an SS doctor Josef Mengele, infamously known for his unethical experiments on twins in the Auschwitz concentration camp, dreamed of creating the perfect human race. (Astor, 1985) Several such examples are found in medical history where the passion of medical research has led professionals to segregate bioethics and flout the Hippocratic Oath (see Figure 1), a 2,500 years old ancient text associated with Hippocrates, known as the “father of medicine”. (Sokol, 2013). There are also examples of government-run research that did not abide by ethical principles and took advantage of the vulnerable population to extract information beneficial for the nation.  (Gordon, 1996)

Current ethical guidelines in Western medicine is guarded by principles such as the Nuremberg Code, the Declaration of Helsinki and the Belmont Report. (Baker, 2017). These important guidelines of medical practice and research differentiates between right and wrong and protects the rights of patients and subjects of medical experiments. Despite of such presence of ethical guidelines, issues in the field of bioethics are still on the heart of the debate world. For example, ethical issues concerning cloning, genetic engineering and euthanasia are all controversial topics as they ignite public disagreement and contradicting views. (Mahgoub, 2015)

Bioethics is intertwined with medical research and plays an important role to ensure that ethical standards are adhered to. This research paper focuses on the extent of ethical neglections in medical research.

The Role of Bioethics and The Surrounding Principles

The prefix ‘bio’ comes from the Greek word ‘bios’ meaning life and the prefix ‘ethics’ comes from the Greek word ‘ethos’ meaning custom. (Pakes, 2013). The origins of the word ‘bioethics’ itself means ‘the custom of life’, or the accepted behaviour of life. (Askins, n.d.). In philosophy, ethics is the considerations of what is right and what is wrong. In medicine, bioethics is the selection of treatments or experimental procedures that provides salvation to the patient or mankind, in accordance with the general moral principles of humanity. (Baker, 2017).

One of the earliest known principles in bioethics is the Hippocratic Oath. The Oath requires a new physician to swear to fulfil his duty, refrain from providing a lethal drug to anyone when asked, to acknowledge his limited competence and seek specialist assistance when complex cases arise and to keep patient records confidential. (Pavur, 2013). Nevertheless, the fundamental principle of the Oath can be defined by the Latin phrase “primum non nocere” which means “first, do no harm”. (Smith, 2005). The Oath is a simple outline of bioethics in medical practice providing a general code of conduct for health professionals. The downside of this Oath, however, is that it conspicuously lacks on addressing the rights of the patient or a subject in an experiment. (Mapes, 2017) In fact, the Oath is solely based on medical practice while bioethics in medical experimentation and research is absent.

Figure 1: The original Hippocratic Oath (North, 2002)[pic 3]

Light was shed upon ethics in medical research soon after World War Two in the Nuremberg Trials held in Nuremberg, Germany in 1947. (Evelyne Shuster, 1997) The American military tribunals trialled Nazi doctors accused of unethical medical experimentations during the holocaust. As a result, justice was finally granted to those subjects that suffered through excruciating pain or lost their lives and the formulation of the Nuremberg Code took place. Telford Taylor, chief prosecutor of the trials had stated that this was a necessary step so that neglecters of ethical practice could be “cut out and exposed before they become a spreading cancer in the breast of humanity”. (Nuremberg Trials Key Moments, 1947). The Nuremberg Code is the first international document advocating rights of the subject in medical research and serves as a blueprint for today’s bioethical principles and maxims. It consists of ten principles requiring strict adherence in an experiment involving human subjects. (Evelyne Shuster, 1997). The Code requires experiments to proceed only when “voluntary consent” of the subject is provided, the experimental design is deemed to “yield fruitful results”, animal experimentation show positive results and all safety precautions have been taken. (Evelyne Shuster, 1997). The Code also grants liberty to the subject to terminate experimentation at any point. The Code was a breakthrough in the field of bioethics and has led to the formulation of several important documents such as the Declaration of Helsinki and the Belmont Report.

In 1964, the World Medical Association established recommendations guiding medical doctors in biomedical research involving human subjects in The Declaration of Helsinki that governs international research ethics and defines rules for “research combined with clinical care” and “non-therapeutic research”. (Association, 2001). Similarly, the Belmont Report, published in 1979 focuses on three basic ethical principles – respect for persons, beneficence and justice.

History of Unethical Medical Research

Along with the rise of fascism, World War Two was also seen as the rise of medical knowledge and surgical techniques. With war came military casualties, famine and outbreaks of diseases due to poor sanitary conditions within the two allies resulting in an increasing demand of medical assistance. (Doctors of Death, 2010). Leaders of nations involved in war understood that a medical leap forward would be profitable as wounded soldiers could be treated expeditiously and sent back to the battlefield, high-ranking officers of the opposing side could be drugged to reveal confidential information when captured and medical discoveries could be made for the benefit of the nation. This triggered unethical medical experimentations on prisoners of war and slaves to “gain a step forward in the battle of world domination”, said Harold Sebring, a US judge in the Nuremberg Trials. (Nuremberg Trials Key Moments, 1947)