REVIEWING ETHICAL STANDARDS IN CONTEXT 
VI 
populations are given special protections in modern society because of their 
limited abilities to protect their own interests. The ethical requirement of 
consent is intended specifically to enable persons to be treated respectfully 
and in accord with their understanding of their interests, and in more limited 
cases according to the judgment of those who are in the best position to speak 
for them. In the Guatemala experiments the most vulnerable populations 
appear to have been targeted specifically because of their inability to protect 
themselves or to have others represent their interests. As explained below, even 
at that time there was a basic conception of voluntary consent and an under- 
standing of differential vulnerability in various populations. Not only is there 
no record of consent to participation in the experiments, there are also several 
examples of active deceit on the part of the researchers. 
2) One ought not to subject people to harm or the risk of harm, even with 
their consent , unless the risk is reasonable and there is a proportionate 
humanitarian benefit to be obtained. 
Morally sound scientific research involving human subjects includes this 
humanitarian principle: the degree of risk should be minimized and never 
be disproportionate to the humanitarian importance of the problem to be 
solved by the experiment. This principle was recognized in the Nuremberg 
Code: experiments on human subjects that risk harm “should be such as to 
yield fruitful results for the good of society, unprocurable by other methods 
or means of study, and not random and unnecessary in nature.” 668 Careful 
and scientifically sound research design is a sine qua non of medical ethics, 
without which it is unethical to ask persons to submit themselves as experi- 
mental subjects. 
The Guatemala experiments were not carefully designed by either current or 
contemporaneous understandings of appropriate scientific methods: modes 
of transmission were used that supervisors warned would not withstand scru- 
tiny, and data were altered or excised before inclusion in summary reports. 
Aggravating the failure to ensure valid methodology is the fact that not all of 
the patients given STDs were treated, making the risks clearly unreasonable. 
Therefore, not only did the researchers put their subjects at gratuitous risk, 
including risk of death in some cases, through this faulty scientific design, a 
violation of the prohibition against unjustifiable harm, but the unreliability 
of the data produced in this fashion further degrades the subjects’ sacrifices. 
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