ETHICALLY IMPOSSIBLE” STD Research in Guatemala from 1946-1948 
Appendix I: Waiver Form Proposed in Preparation for the Terre Haute 
Experiments 
-3- 
’’statement of procedur^^vhich I have signed to evidence such fact. 
"I hereby assume all risks of such tests and, acting for myself, 
my heirs, personal representatives , and assigns, do hereby release 
and their personnel, r.nd all 
(institutions) 
others from all liability, including c.lains anu suits at law or in 
equity, for any injury, fatal or otherwise, erhich may result from 
the tests. 
Witnesses : 
(signature ) 
(date) 
OFFICER IN CHARGE 
Consent is heroby given for the above named inmate to parti- 
cipate in the investigation of prophylaxis for gonorrhea. 
(Signature of officer in charge) ” 
140 
