REVIEWING ETHICAL STANDARDS IN CONTEXT 
VI 
of medicine, as is clear from the fact that Dr. Ivy was able to identify them 
and the American Medical Association promulgated them, although they 
were not understood and appreciated as fully as they are today. Certainly, the 
evidence suggests that the physicians and officials responsible for the Guate- 
mala experiments recognized that these rules were in circulation and had 
some appreciation of their implications for research, as Dr. Cutler’s reaction 
to the Kaempffert article shows. As medical professionals and public officials, 
they had a moral and professional duty to recognize these rules and to appre- 
ciate their implications for research practices. 
Yet the physicians and officials responsible for the Guatemala experiments 
violated all of these requirements. Not only was there no evidence of volun- 
tary consent by the subjects, but also they were clearly exposed to the risk of 
serious physical harm posed by contracting various diseases. Specific corre- 
spondence and other records show that some subjects were exposed to, and 
sometimes suffered, significant injury when treatment and available medicines 
could have prevented such harms . 693 Compounding these issues was the fact 
that even had risks been reasonable, there was no proportionate humanitarian 
benefit to be gained, as the experiments were not designed in a scientifically or 
morally responsible fashion. There is no evidence that any of the researchers 
volunteered to subject themselves to the experiments, a condition that we 
might today view as quaint and irrelevant but which was not uncommon at 
the time and would at least have established that they were willing to consent 
to the risks to which they exposed others without seeking their consent. 
Evaluating General Mitigating Arguments 
Mitigating factors can moderate or reduce the blame deserved by individual 
actors, as well as confound the determination of individual blameworthiness, 
independent of judgments regarding the rightness or wrongness of the actions 
themselves. Mitigating conditions of a general nature include: 
• Non-negligent factual ignorance; 
■ Culturally induced ignorance about relevant moral considerations; 
■ Evolution in the interpretation and specification of moral principles; and 
■ Indeterminacy in an organization’s division of labor, with the result that 
it is unclear who has responsibility for implementing the commitments of 
the organization . 694 
101 
