Human Dignity and Bioethics

22 | F. Daniel Davis
been reported. The preceding decade of the 1960s was marked by
repeated disclosures of unethical conduct in clinical research. From
1963 to 1966, for example, the Willowbrook State School for “mentally
defective persons” in New York was the site of a study of the
natural history of infectious hepatitis and of the effectiveness of
gamma globulin in its prevention and treatment. Researchers at Willowbrook
deliberately infected children with the hepatitis virus, later
arguing in their own defense that infection was inevitable due to
the poor hygienic conditions at the school. Willowbrook was closed
to new admissions during the study, but space remained available
in the institution’s hepatitis program—and parents who wished to
admit their children to the school had little choice but to agree to
their enrollment in the study. The year 1963 also marked the initiation
of a study of cancer immunology at New York City’s Jewish
Chronic Disease Hospital, where clinical investigators injected live
cancer cells into patients hospitalized for various chronic diseases—
without the patients’ knowledge (although the researchers did claim
that oral consent had been sought but not documented). And in
1966, in the New England Journal of Medicine, Harvard’s Henry K.
Beecher (who chaired the Harvard ad hoc committee that proposed
a neurological standard for determining death) described his analysis
of 22 ongoing clinical studies involving unethical practices in human
subjects research. 9 Concluding that such practices were far from
uncommon, Beecher ended his controversial exposé with a broadside
against the utilitarian defense of their legitimacy: “An experiment
is ethical or not at its inception; it does not become ethical post
hoc—ends do not justify the means.” 10 Thus, with the uproar over
Tuskegee, a steadily mounting concern, fueled by one revelation of
abuse after another, reached such a crescendo that in 1973 Congress
began a series of hearings, aiming both to prevent further abuses and
to grapple with the paradoxical challenge of harvesting the fruits of
biomedical science and technology while mitigating their dangers.
The National Commission was born of this resolve.
Over the next four years, the Commission issued seven reports. 11
Several were in fulfillment of the Commission’s legislative mandate:
Research Involving the Fetus (1975), Research Involving Prisoners
(1976), Research Involving Children (1977), Psychosurgery: Report and
Recommendations (1977), Disclosure of Research Information under the