Expert Considers Some Ethical Guidelines for Conducting Research

The name Josef Mengele is synonymous with the perverse "medical experiments" conducted by the Nazis on concentration camp inmates.

Mengele — who eluded capture after the war and died in Brazil in 1978 — was a doctor at Auschwitz, where he conducted dubious research that killed many inmates, and was often the one who selected which inmates would be immediately sent to the gas chambers, and which would be worked to death, or near death, as slave laborers.

But according to Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, it wasn't the sadistic Mengele, but another German doctor, Gerhard Rose, widely respected in German academic circles, who perhaps best epitomizes the moral lapses of accomplished physicians and scientists during the Nazi period. Rose conducted research on unwitting subjects and, in the process, gleaned some medical knowledge in areas such as the effects of hypothermia, decompression, and typhus and typhoid.

Caplan, known for offering opinions on medical controversies, added that it was the actions of doctors like Rose — and the moral justifications for those actions — that have framed the ongoing debate surrounding research ethics. Some ongoing questions include: What are the parameters of research and is a scientist's first responsibility to the subjects or to society at large?

"Mengele became a very convenient figure for everything that went on in the name of research," Caplan — author or editor of 25 books, including When Medicine Went Mad: Bioethics and the Holocaust — told a group of roughly 130 college professors and high school teachers who attended a January 8 faculty development conference at Holy Family University in Northeast Philadelphia.

The SouthEastern Pennsylvania Consortium for Higher Education, which represents eight smaller institutions in the area, including Holy Family and Chestnut Hill College, sponsored the half-day of programming titled: "Research: Teaching, Technology & Integrity." Caplan, the keynote speaker, addressed "Current Challenges in Research Ethics."

Caplan added that many professors and doctors with university appointments, such as Rose — considered at the time a world authority on typhus and typhoid — were initially reluctant to conduct research on prisoners. Rose and others later relented — he was told that 50 German soldiers were dying from typhus every week — reasoning that the subjects were going to die anyway, so it was ethical to use them in order to gain knowledge that would help the country's war effort.

According to Caplan, one of the advances that came out of Nazi wartime experiments is the modern life-jacket. After putting inmates in cold water and watching them freeze to death, Nazi doctors learned that the longer someone's head stays out of the water, the longer they can stay alive.

Rose received a 10-year prison sentence at the Nuremberg Trials.

"He wasn't hung. He had exhibited moral agonizing, and that counted for something," surmised Caplan.

According to Caplan, a bedrock principle of contemporary research ethics is gaining consent from all subjects before they take part in any type of medical experiment or drug trial. That precept was a direct response to the moral argument offered by Rose at Nuremberg, claiming that in some cases the needs of the many outweigh the needs of the few.

Other research safeguards that have evolved include the need for scientists using human and even animal subjects to go before institutional review boards, a development that came somewhat later to the United States than it did in Europe. Scientist must also demonstrate that they have no conflict of interest concerning the outcome of any particular study.

But, even as bioethical issues dominate the news, scientists and doctors can't even agree on the definition of what constitutes research, let alone whether it is being conducted ethically or not, said Caplan.

He addressed the recent, highly publicized case in Washington State where doctors at Children's Hospital in Seattle — following the instructions of the parents of a severely brain damaged 9-year-old girl who cannot move on her own — have utilized a number of measures, including the use of hormones, to stunt the child's growth and make it easier for the parents to care for her.

Caplan argued that a case such as this should be considered research, and be subject to the same ethical scrutiny as any other scientific study. But partly because no new drugs or procedures are being tested, the Seattle doctors have been afforded more latitude than they should have been, he noted.

Sister Maureen McGarrity, vice-president for academic affairs at Holy Family, left the program thinking that, even with all the safeguards that are in place, research on human subjects remains fraught with ethical pitfalls, and it's up to the academic community to constantly monitor and police research.

"Abuses can and do occur," she said. "While we all want progress, we don't want it at the expense of these human subjects."



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