REVIEWING ETHICAL STANDARDS IN CONTEXT 
VI 
when those who cannot be excused are physicians and public officials who are 
dedicated to finding cures for serious diseases. Nonetheless, they bear moral 
responsibility when they put their actions and their science above moral rules 
on the ground that their science is more important than the rules. Neither a 
bioethics commission nor the American people should accept such an excuse. 
Again, the documentary evidence indicates that the investigative team in 
Guatemala recognized the relevant moral considerations — even if these moral 
considerations were devalued by some as mere defensive measures against bad 
publicity. And, given their positions of scientific and medical responsibility, 
they could and should be held culpable for a failure to recognize the moral 
considerations of their work. Yet these concerns were routinely ignored or 
dismissed in favor of the continued pursuit of new scientific knowledge with 
minimal external interference . 696 An appreciation of possible objections to 
their work on moral grounds (whether they agreed with these objections or 
not), and the practical consequences of those objections for the future of the 
activities in Guatemala, is reflected clearly in the extensive interest in mini- 
mizing knowledge of the research program beyond a small circle of insiders 
associated with the VDRL . 697 
Why was Guatemala found to be such an opportune environment for these 
excesses? Among the relevant factors was surely the eager cooperation of 
Guatemalan authorities. As well, it is difficult to ignore the possibility that 
class, ethnic, and racial differences were among the factors that numbed the 
researchers to the larger moral context of their work. It is plausible that once 
they initiated the research program, the researchers became increasingly 
inured to the ethical violations of which they were a part. Not only was the 
VDRL itself a limited circle of insiders, the researchers in Guatemala oper- 
ated as a still smaller, mutually reinforcing group culture far from home, 
distant from peers, and in a very different societal environment from that of 
the United States. These factors may have contributed to a collective numbing 
to ethical norms, a hypothesis that may help to explain the conduct of the 
researchers but by no means excuses it. 
It cannot be said, however, that the chain of command was faulty with 
respect to professional responsibility in the context of the Guatemala 
research. Despite the physical distance between the research sites and the 
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