The film “Miss Evers’ Boys”

Full Answer Section

• Ethical Principles Involved:
  • Beneficence: The core ethical principle of doing good and acting in the best interest of the patient. The experiment violated this principle by deliberately denying effective treatment when it became available, causing prolonged suffering and premature death. Nurse Evers' internal conflict stemmed from her desire to uphold beneficence while being compelled to violate it.
  • Non-maleficence: The principle of "do no harm." The experiment actively violated this principle by allowing preventable harm to occur, knowing that an effective treatment existed. Nurse Evers was caught in a system that forced her participation in this harm.
  • Scientific Integrity (misguided): The researchers were ostensibly pursuing scientific knowledge (understanding the natural history of syphilis). However, their pursuit grossly overrode basic human ethical considerations, demonstrating how scientific goals can be distorted without strong ethical oversight.

2. The Dilemma of Loyalty vs. Moral Obligation (or Fidelity vs. Autonomy/Justice):

• Description of the Ethical Dilemma: Nurse Evers felt a deep loyalty to the Public Health Service (PHS), her employers, and particularly to Dr. Brodus and Dr. Waller, who she saw as her superiors and mentors. She believed in the "good" they were doing by providing some care to a vulnerable, underserved population. This loyalty clashed with her growing awareness of the injustice and deception involved in withholding treatment and the potential for these men to make autonomous decisions if fully informed. She was loyal to an institution that was perpetrating an injustice.
• Ethical Principles Involved:
  • Fidelity: The principle of faithfulness, loyalty, and promise-keeping. Nurse Evers was trying to be faithful to her employers and the perceived mission, even as that mission became ethically corrupt.
  • Autonomy: The right of individuals to make informed decisions about their own healthcare. The experiment grossly violated this principle by failing to obtain true informed consent. The men were lied to about their condition and the nature of the study, denying them the right to choose treatment. Nurse Evers' participation, however unwitting initially, perpetuated this violation.
  • Justice: The principle of fairness and equitable distribution of burdens and benefits. The experiment violated justice by targeting a specific, vulnerable, and marginalized population (poor, Black men in rural Alabama) for a study that denied them treatment available to others. Nurse Evers was part of the system that created and maintained this injustice.

Violation of the American Nurses Association (ANA, 2015) Code of Ethics

The Tuskegee Syphilis Experiment profoundly violated numerous provisions of the ANA (2015) Code of Ethics for Nurses. A particularly egregious violation can be found in:

• Provision 2: "The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population."

  • Violation: In the Tuskegee experiment, the primary commitment of the nurses involved (including Nurse Evers, under duress) shifted from the well-being of the individual patients to the dictates of the research protocol. Once penicillin became the standard treatment for syphilis in the 1940s, the ethical imperative was to provide that treatment to the infected men. By withholding this known effective treatment for decades to observe the natural course of the disease, the nurses were forced into a position where their primary commitment became the "study" rather than the "patient." They were implicitly, or explicitly, directed to prevent the men from accessing treatment elsewhere, further cementing this violation of their primary commitment. This allowed the men to suffer from debilitating and ultimately fatal effects of untreated syphilis, directly contradicting the fundamental nursing responsibility to act in the patient's best interest.

Protecting Human Subjects: A Different Approach

If I had been involved with the Tuskegee Syphilis Experiment at any point, particularly once penicillin became available in the 1940s, the most critical change I would have made to protect human subjects is to immediately advocate for and ensure the provision of penicillin treatment to all infected participants.

Why this specific change:

I would choose this specific change because it directly addresses the most egregious ethical violation: the deliberate denial of a known effective cure. It prioritizes the fundamental principles of beneficence (doing good), non-maleficence (doing no harm), and justice (equitable access to care) above any perceived scientific benefit of observing untreated disease.

What benefit could it have provided:

This change would have provided several profound benefits:

1. Preservation of Life and Alleviation of Suffering: This is the most obvious and critical benefit. Hundreds of men would have been cured of syphilis, preventing the progression to debilitating and fatal stages (e.g., neurosyphilis, cardiovascular syphilis). They would have lived longer, healthier lives, free from preventable pain and disability.
2. Upholding Human Dignity and Autonomy: Providing treatment would have respected the men's inherent human dignity. Furthermore, it would have paved the way for truly informed consent. Instead of deception, the men could have been genuinely informed about their condition and the availability of a cure, allowing them to make autonomous choices about their health and participation in any new, ethical follow-up study (if one were even deemed necessary or justifiable after treatment).
3. Restoration of Trust (to a degree): While the initial deception would have been hard to overcome, providing treatment would have been a tangible step towards rectifying the harm and rebuilding trust between the medical establishment and the Black community. The long-lasting legacy of distrust that the Tuskegee experiment caused could have been mitigated, potentially leading to greater participation in public health initiatives and clinical trials from marginalized communities in the future.
4. Ethical Precedent: By refusing to continue the unethical observation and demanding treatment, it would have set a crucial ethical precedent within the public health service and the medical community at large, highlighting the paramount importance of patient well-being and ethical research conduct over scientific curiosity. It could have influenced the development of stronger ethical guidelines for human subject research much earlier.

This single change, while simple in concept, would have fundamentally altered the tragic course of the experiment, protecting countless lives and beginning the long journey toward repairing the profound ethical breaches committed.

Sample Answer

Ethical Dilemmas in "Miss Evers' Boys" and the Tuskegee Syphilis Experiment

"Miss Evers' Boys" powerfully portrays the moral complexities and tragic consequences of the Tuskegee Syphilis Experiment. Two prominent ethical dilemmas faced by the characters, particularly Nurse Eunice Evers, were:

1. The Dilemma of Care vs. Research Imperative (or Beneficence vs. Scientific Pursuit):

• Description of the Ethical Dilemma: Nurse Evers, as a healthcare professional, was dedicated to caring for her patients and alleviating their suffering. However, her role within the experiment required her to withhold life-saving treatment (penicillin, once available) from these men to observe the natural progression of syphilis. This created an agonizing conflict between her professional duty to provide beneficial care to individuals and the directives of the researchers to adhere to the study's design for scientific knowledge. She believed she was providing the "best care" within the confines of the study, which included physical examinations, free meals, and burial stipends, but this "care" was ultimately a cruel substitute for curative treatment.