“ETHICALLY IMPOSSIBLE” STD Research in Guatemala from 1946-1948 
egregious moral wrongs and because many of the individuals involved held 
positions of public institutional responsibility. 
Careful consideration of the ways these actions violated ethical principles both 
honors the memory of these victims and helps ensure that society learns from 
these offenses. To that end, the Commission turns to a set of fundamental 
moral commitments that find expression in moral philosophy, theological 
traditions, and more highly specified codes, rules, and regulations. An ethical 
assessment of the Guatemala experiments does not, strictly speaking, require 
a comprehensive set of ethical principles, which would be more usefully 
invoked to evaluate experiments that do not so blatantly violate widely recog- 
nized fundamentals. Instead, for the purpose of creating a structure upon 
which to evaluate past violations and in order to help inform future practices, 
the Commission elucidates three longstanding and widely accepted moral 
principles of particular relevance to the Guatemala experiments. These moral 
principles are also fitting to guide current conduct, with exceptions allowed 
only with stringent justification. Each of these three principles is necessary, 
but no single principle is alone sufficient for the justification of an experiment 
involving human subjects. 
1) One ought to treat people fairly and with respect. 
Treating persons fairly and with respect prohibits choosing more vulnerable 
people upon whom to experiment when research could be done with less 
vulnerable populations. This principle also requires special steps and precau- 
tions to protect those who cannot protect themselves or give informed consent 
under any circumstances. Vulnerable groups should not disproportionately 
bear the burdens of research. The violation of this principle of respect becomes 
all the more serious an offense when the risks of research are imposed on 
vulnerable populations without their consent, or on those who are both 
vulnerable and incapable of providing consent. As stated in the first sentence 
of the Nuremberg Code, “the voluntary consent of the human subject is abso- 
lutely essential .” 667 
The Guatemala research targeted some of the most vulnerable groups in any 
society (prisoners, conscripted soldiers, institutionalized psychiatric patients, 
and children), and also was conducted in an underdeveloped country with 
pervasive social inequalities that exacerbated their vulnerabilities. Such 
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