“ETHICALLY IMPOSSIBLE” STD Research in Guatemala from 1946-1948 
Examining these four potentially mitigating conditions in the context of 
the Guatemala research, the Commission finds, first, that the researchers 
were well aware of the factual circumstances. While much may have been 
unknown about the prevention and treatment of the STDs being studied in 
Guatemala, the devastating impact of the diseases themselves on individuals 
and communities was well understood. It was exactly this knowledge of the 
consequences of STD infection that motivated the researchers to pursue this 
research program despite the ethical objections they knew would be voiced if 
others learned of their work. 695 
It is true that during the period 1946 to 1948 the interpretation and specifica- 
tion of research ethics principles were evolving. However, these researchers 
constituted a small and coherent professional network that had previously 
engaged in analogous studies in the United States. The de facto standards that 
they applied in the Terre Haute prison, particularly with respect to written 
consent, stand in stark contrast to those in the Guatemala experiments. The 
extensive attention given in the former case to questions regarding research 
involving intentional infection with STDs, consent procedures, and unique 
issues related to research in prisons provides clear evidence that the Guatemala 
investigators were familiar with such concerns. Although the interpretation 
and specification of moral principles may have been gradually evolving during 
this period, the Terre Haute work indicates that these concepts were not unfa- 
miliar to the researchers. In this sense, the defense of culturally induced moral 
ignorance is inadequate. 
There is another sense of culturally induced moral ignorance, one that may 
have stemmed from the small circle of researchers themselves. Perhaps they 
believed that culturally available moral concerns were not binding on them 
because they took their research to be more important than respecting the 
readily available human subjects, obtaining their consent, and avoiding need- 
less harm. They might have known that these were moral concerns to which 
the public expected them to adhere, hence their efforts at secrecy so as not to 
be subject to criticism from their own medical colleagues and from the public. 
But even if they took these moral concerns as purely practical side constraints, 
to be evaded if at all possible, this does not lessen their culpability. Indeed, it 
makes them more arrogant, for they then would not have the excuse of igno- 
rance or compulsion. We may find this conclusion especially disconcerting 
102 
