Structural injustice in USPHS STD research in Guatemala

Extending the 2011 report of the Presidential Commission for the Study of Bioethical Issues, “Ethically Impossible": STD Research in Guatemala from 1946 to 1948, this paper examines structural injustices that suffused the social and institutional relations fundamental to the moral landscape of this USPHS research. In particular, I argue that racism, sexism, and heteronormativity contributed to, as the Commission put it, “reprehensible exploitation of our fellow human beings” and “unconscionable violations of ethics.” An understanding of the gendered, sexualized, and racialized contexts in which these experiments were developed and conducted is necessary for an ethical analysis that recognizes, for example, the unique violations experienced by sex workers - the only all women group of research participants, and by indigenous Guatemalans who were disproportionately institutionalized as soldiers, prisoners, and psychiatric patients. Combined with medical arrogance and military support, these structural injustices deepened the vulnerability and oppression of Guatemalan research participants and facilitated the moral wrongs of US and Guatemalan researchers. Thus structural features of the research context are critical and necessary subjects of ethical assessment, and point to the need for a multi–layered notion of responsibility that accounts not only for individual but also institutional and structural wrong-doing. Finally I identify potential contemporary US responses that attempt to address these structural injustices.