REVIEWING ETHICAL STANDARDS IN CONTEXT 
VI 
for military readiness, as had been shown during World War II . 699 Experi- 
ments involving ionizing radiation were highly speculative and the benefits 
remote, whereas the need for improvements in the treatment and prevention 
of STDs was intense 700 and, especially with the advent of penicillin, seemingly 
within reach. But the Guatemala experiments were initiated after the war had 
ended and while the country was at peace, so there was no immediate mili- 
tary necessity in the form of an existential threat to the United States. A more 
plausible argument is that there was a pressing public health need to address 
these human scourges that had caused, and continued to cause, vast suffering 
throughout the world. 
There is no question that campaigns for the eradication of dire threats to 
the public health have often been justifiably aggressive, in accordance with a 
strongly utilitarian moral philosophy. However, not all threats to the public 
health are so grave that any and all interventions may be justified by a crude 
utilitarianism. Whether the threat to public health posed by a particular 
disease outbreak is severe enough to justify aggressive tactics that temporarily 
suspend our usual ethical norms is itself an important question of ethics and 
policy . 701 Only after such an assessment is decided in favor of suspending our 
usual ethical norms should the question be considered whether there is suffi- 
cient justification for selecting one location or population to be subjected to 
overriding typical rights. 
Moreover, when the public health activity in question is experimental (as was 
the case in Guatemala), the justificatory bar must be set still higher in order 
to comply with the principles and requirements of research involving human 
subjects. The corresponding ethical burden to justify the selection of loca- 
tions and populations is considerably greater in the context of human subjects 
research. In research, one justification for selecting a certain site or population 
could be that the disease does not occur with adequate frequency in other 
places to make experimental work feasible elsewhere. This was one of the 
justifications for the location of the Tuskegee syphilis study. Again, however, 
the rationale for place or population selection does not excuse experimenters 
from other ethical requirements, such as informed consent, and limiting fore- 
seeable harm, requirements that were grievously and notoriously violated in 
the Tuskegee experiment and elsewhere. 
105 
