MHA6060 WEEK 2 DISCUSSION AND PROJECT INSTRUCTIONS

Copyright 2016 American Medical Association. All rights reserved.

JAMA Revisited

November 4, 1916

The Right and Wrong of Making Experiments on Human Beings

To heal the sick and to prevent disease and death are the ser- vices to society to which the physician devotes himself. Just so far as he is capable of performing these functions, he is under obligation to perform them. But the ability of medical men to cure or check disease is often limited because the nature of the disease and suitable methods of treating it are still unknown. On every side the effect of increased knowledge in giving increased power is manifest. Greater knowledge is certain to yield greater ability to restore the sick to health. Again, just so far as the physician is capable of doing so, he is as much under obligation to secure further knowledge and to diffuse it as he is under obligation to apply his skill to the individual in distress. This duty of learning is the warrant everywhere for the painstak- ing labors of the medical investigator, whether he is in the laboratory experimenting on animals, or in the hospital thor- oughly and critically studying his patients.

The duty of learning, the duty of making advances in diagnosis and treatment, is certain to involve the application of new methods or new medicaments. Fortunately, observa- tions which can be made on animals offer reasonable assur- ance as to the safety of new procedures before they need to be tried on man. If a promising mode of diagnosis or treat- ment has been carefully worked out on lower animals, there appears to be no ethical objection to applying it to a human being who is in distress when it is reasonable to believe that its application would be beneficial. Devotion to the duty of learning, however, may tempt investigators to make tests on their patients without due consideration, tests perhaps more likely to be valuable to others than to the person on whom they are made. Or procedures may have mixed values, in part beneficial to the patient, in part beneficial to his fellows. These situations raise an important ethical question: To what limit is the testing on human beings of a previously untried medical agency justifiable?

Just because an operation is a minor one and is very likely to be harmless, there is danger of assuming that the new knowledge to be obtained from testing it justifies the test, even without the consent of the person on whom it is to be tried. Such an assumption is a serious error. There is no more primitive and fundamental right which any individual

possesses than that of controlling the uses to which his own body is put. Mankind has struggled for centuries for the rec- ognition of this right. Civilized society is based on the recog- nition of it. The lay public is perfectly clear about it. Any hos- pital official or physician known to commit or to allow violation of the sacredness of the person becomes at once the object of hostility. And the law, as an expression of public conscience, declares that deliberate injury done to the body of another is an assault, and provides severe punishment for it. Society as now constituted will obviously not countenance any operation performed for the satisfaction of the operator or for the assurance of the investigator, whether or not for the immediate benefit of others, unless the consent of the person on whom the operation is to be performed has previ- ously been obtained.

No doubt the justice of this ethical standard is generally recognized in the medical profession, and the spirit of the Hippocratic oath shows that from the earliest times this pri- mary regard for the patient has been the core of the physi- cian’s honor. Occasionally, however, reports appear which indicate that investigators have made tests on human sub- jects which possibly may not have been intended directly for the benefit of the person concerned. In some instances it has not been clear that the consent of the subject was obtained. In other instances, in which dependents have been subjects, the superintendent of the hospital or asylum has been responsible for his charges, and it has not been clear whether he has given his consent or secured the sanction of relatives. It is clearly the duty of the physician to secure the consent of the patient or of the patient’s guardian in case the patient himself is not capable of granting consent before performing any mutilating operation. The medical profession is certainly not called on, in any sense, to support the physician who transgresses the elementary principles of ethics.

Especially are the reputation and esteem of medical men endangered by any failure on their part to stand firmly for the fundamental right of the individual to respect for his own person. For the sick commit themselves to the care of the physician and surgeon helplessly and with implicit trust that their welfare alone will be considered. Any practitioner or investigator, no matter how laudable his motives, who fails in scrupulous regard for this trust is liable to do incalculable harm by rousing suspicions, fears and disrespect as to the character of medical service.

JAMA. 1916;67(19):1372-1373.

Editor’s Note: JAMA Revisited is transcribed verbatim from articles published previously, unless otherwise noted.

Section Editor: Jennifer Reiling, Assistant Editor.

2680 JAMA December 27, 2016 Volume 316, Number 24 (Reprinted) jama.com

Copyright 2016 American Medical Association. All rights reserved.

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