Ethical Use of Prisoners in Human Research
Introduction and Background
The use of humans as research subjects has been a long debated issue within the scientific community. There are a lot of factors that go into regulating such research studies, like limiting coercion, undue inducement, and vulnerability of the population of the subjects in the study. To help control these issues, there have been many guidelines that have been implemented to ensure the safety and wellbeing of the research subjects.
Within healthcare and medical research, certain groups of people are offered special services and protections because they are considered vulnerable. Vulnerable populations include children, persons with mental disabilities, women who are pregnant, and prisoners. The CIOMS International Ethical Guidelines for Biomedical Research define ‘vulnerable persons’ as “those who are relatively (or absolutely) incapable of protecting their own interests. More formally, the may have insufficient power, intelligence, education, resources, strength, or other needed attributes to protect their own interests.” (6) Therefore, there are detailed guidelines that are designed to protect the rights and welfare of any vulnerable persons by requiring justifications for involving such individuals in research. It is essential for healthcare workers and researchers to identify subjects as vulnerable or not to make sure that resources are properly allocated to ensure that special protections and benefits are given to those who need it (8). There has been a long struggle to define vulnerability, which has led to arguments about its value as a factor in the distribution of resources an it’s appropriateness as a guiding principle in bioethics. History of the use of Prisoners
The abuse of the use of humans in research in recent history has made it evident for the need for a code of ethics protecting human research subjects. Both Nazi Germany and the Imperial Japanese Army took advantage of the poverty, defenselessness, and dependency of others by using the latter to serve their own needs without adequate compensation for these disadvantaged individuals or groups (6).
When Adolf Hitler came to power, he implemented a series of laws promoting racial segregation and the protection of the “Arian race”. These laws were created in partnership with a portion of the German medical community. One of the first laws that was enacted was called the Sterilization Act. This called for the sterilization of subjects with certain medical and mental disorders in order to remove the genetic abnormalities that caused these conditions from the gene pool, thereby purifying and improving the “German race.” The scientists involved in implementing these laws argued that they were performing these procedures “for the benefit of the nation and the health of subsequent generations, and not for the individual patient.” They believed they were part of a ‘holy mission’, which would benefit society as a whole. (5)
In addition to the Sterilization Act, the German medical community was involved in the implementation of the Nuremburg Laws, which were encated for the purpose of the “purification of the blood of the German people. (5) The involvemtn of the medical community in employing these laws demonstrates the relaxation of ethical principles. These laws required that couples undergo premarital medical examinations in order to prevent the spread of ‘racially damaging diseases’. In addition, as the war was approaching the Germans needed to free up hospital beds for wounded soldiers, and thus, the medical community was instructed to perform euthanasia on any incurable patients. This program was eventually extended to include the extermination of those who constituted a threat to society; those with links to criminals, behaved antisocially, prostitutes, drifters, and homosexuals. This practice of mass extermination served as the model for the...
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3) Gostin, L. 2007. Biomedical Research Involving Prisoners. American Medical Association 297 (7), 737-740.
4) Levine, C & Faden, R. et al. 2004. The Limitations of “Vulnerability” as a Protection for Human Research Participants. The American Journal of Bioethics 4 (3), 44-49.
5) Lopez-Munoz, F. & Alamo, C. et al. 2006. Psychiatry and Political-Institutional Abuse From the Historical Perspective: The Ethical Lessons of the Nuremberg Trial on Their 60th Anniversary. Progress in Neuro-Psychopharmacology and Biological Psychiatry 31, 791-806.
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7) Nickel, P. 2006. Vulnerable populations in Research: The Case of the Seriously Ill. Theoretical Medicine and Bioethics 27, 245-264.
8) Rouf, M. 2004. Vulnerability, Vulnerable Populations, and Policy. Kennedy Institute of Ethics Journal 14 (4), 411-425.
9) Thomas, D. 2010. Prisoner Research- Looking Back or Looking Forward? Bioethics 24 (1), 23-26.
10) York, D. 2003. Protection of Human Subjects in Research Trials. Am. J. END Technol. 43, 54-59.
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