“ETHICALLY IMPOSSIBLE” STD Research in Guatemala from 1946-1948 
No such justification was available in the Guatemala experiments. Rather, it 
is likely that the Guatemalan sites were chosen precisely because they would 
be out of public view in the United States and beyond the reach of our laws 
and research norms. The subjects may have been viewed as powerless and 
easily available; and local authorities were not merely cooperative but enthu- 
siastic partners. In Guatemala, the diseases were not especially endemic to 
the local community, as was the case in Tuskegee . 702 Given the focus of the 
Guatemala research on prophylaxis and diagnosis, the majority of the subjects 
were not already infected, again unlike Tuskegee. A “methodological” justi- 
fication was the opportunity to use commercial sex workers — whose work 
was legal in Guatemala but not in the United States — as vectors to study 
STDs “as acquired in the usual manner .” 703 A possible remaining but clearly 
unacceptable explanation for choosing Guatemala would reflect the notion 
that the Guatemalans were a suitable, if not preferable, experimental popula- 
tion by virtue of poverty, ethnicity, race, remoteness, national status, or some 
combination of these factors. Stated differently, the commercial sex workers, 
prisoners, psychiatric patients, and soldiers may have been seen as convenient 
and, on the whole, captive. But convenience, however expedient, is by itself no 
moral justification, as the Belmont Report cogently concluded decades later . 704 
The fact that local authorities in Guatemala made their institutions available to 
the U.S. researchers similarly fails to provide any moral justification. Perhaps 
the U.S. officials and physicians convinced themselves that the Guatemala 
authorities somehow represented the interests of the potential subjects, an 
argument that is hardly plausible under the circumstances, and in any case not 
one that was forthrightly stated or likely to be persuasive upon scrutiny. The 
materials available to the Commission provide only limited insight into the 
decision-making processes of the Guatemalan health authorities and govern- 
ment officials, but the U.S. researchers had ample authority, experience, and 
opportunity to have prevented moral wrongs from occurring, independent of 
the decisions and actions of their Guatemalan partners. The cooperation by 
the Guatemalan health authorities and government officials fails to provide 
moral justification for the actions of Dr. Cutler and others. Rather, cooperation 
by Guatemalan health authorities and government officials also reveals their 
culpability in allowing these wrongs to be perpetrated. 
106 
