“ETHICALLY IMPOSSIBLE” STD Research in Guatemala from 1946-1948 
I n the Commission’s view, the Guatemala experiments involved unconscio- 
nable violations of ethics, even as judged against the researchers’ own 
understanding of the practices and requirements of medical ethics of the day. 
Many of their actions disregarded principles widely accepted as applicable 
across time, as well as the standards of our own time that are embodied 
in the ethics and regulation of biomedical research today. The Guatemala 
experiments could not be approved under the current system for protecting 
human subjects in U.S. -funded research. Widely discussed cases in the post- 
World War II era with some similar features have led to a greater appreciation 
and articulation of the moral principles underlying medical research. A clear 
consensus has emerged that medical research must not undermine the very 
human flourishing it seeks to advance in future patients. The Guatemala 
experiments and other troubling violations of this norm that have come to 
light in the last 60 years truly shock the conscience, precisely because of their 
medical context. 660 
Current Human Research Protections and Ethical Requirements of Our 
Own Time 
The standards of ethical human subjects research today are expressed in the 
medical ethics literature and through government regulations and inter- 
national covenants and declarations. All of these documents share certain 
principles. Informed consent, called for by the principles of autonomy and 
dignity, is a cornerstone, as are requirements for minimization of risks, a 
reasonable balance of risks and benefits, sound scientific justification, protec- 
tion of privacy and confidentiality, and special protections for those who are 
especially vulnerable, including minors, prisoners, and those with impaired 
decision making. 661 Crucially, a careful and accountable independent review 
is required prior to the initiation of clinical research. 
None of these elements were satisfied in Guatemala. As the Commission’s 
investigation shows, there is no evidence that consent was sought or obtained 
from the individual subjects who were the subjects of the research. 662 On 
the contrary, there were examples of active deceit. 663 Individual experiments 
appeared to have been haphazardly designed and initiated with little apparent 
appreciation for the relative risks and benefits to research subjects or the artic- 
ulation of a sound scientific justification for particular research designs. 664 
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