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 multilayered 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.
Diversity and culture
Ethics, professional and legal requirements
Define structural injustice
Describe structural injustices operative in 1940's USPHS STD research in Guatemala
Discuss possible contemporary US responses to this research
Keyword(s): Research Ethics, Social Justice
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I have written multiple peer-reviewed articles related to justice in the health and health care realms and am currently researching and writing a related book-length manuscript. These critical ethical analyses have contributed substantively to contemporary health justice discourse.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.