REVIEWING ETHICAL STANDARDS IN CONTEXT 
VI 
Many of the experiments, particularly those involving intentional exposure to 
syphilis, gonorrhea, or chancroid, would fail to satisfy any serious assessment 
of risks to individual subjects in medical research. 
The research specifically included populations that are currently recognized as 
vulnerable and thereby deserving of additional safeguards to ensure adequate 
protection for human subjects. Prison inmates, institutionalized and mentally 
disabled individuals, and children were among the groups most frequently 
included in the Guatemala experiments. Federal regulations, international 
codes, and the ethics literature today all acknowledge that research involving 
these groups raises unique issues requiring additional attention . 665 These 
requirements recognize the challenges in ensuring adequate informed consent 
in vulnerable populations as well as the risk that members of these groups could 
be unjustly included primarily as convenient sources of research subjects. 
The researchers in Guatemala and their immediate supervisors at the VDRL 
appear to have had considerable latitude in the design and conduct of indi- 
vidual experiments, with little evidence of substantive independent review 
for the conduct of the research. On the contrary, substantial evidence reflects 
efforts by the researchers to limit knowledge of the Guatemala activities as 
much as possible to colleagues predisposed to support it . 666 The experimenters 
in Guatemala, both those from the United States and their local colleagues, 
consistently failed to act in accordance with our contemporary understanding 
of human rights and morality in the context of research. 
Longstanding Ethical Principles 
In the Commission’s view, the Guatemala experiments involved gross viola- 
tions of ethics as judged not only in light of modern human research ethics, 
but also against the researchers’ own understanding of medical ethics prac- 
tices and requirements of the day. The Commission believes not only that 
there were moral wrongs carried out in Guatemala, but also that some of 
the participants were morally culpable and blameworthy for these wrongs. 
Admittedly, making moral judgments about past actions and agents is not a 
straightforward process and is not without its hazards. In this case, however, 
the usual challenges associated with making moral judgments about the 
past are not substantial obstacles for the Commission in reaching its conclu- 
sions because many of the actions undertaken in Guatemala were especially 
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