In 1966, an anesthesiologist published a paper that would change medical history in the United States. It did so by getting people very, very angry. Perhaps people should have been even angrier.
In his paper, Henry K. Beecher pointed out that "consent" wasn't enough. In an article in The New England Journal of Medicine, he pointed out 22 cases of experimental studies that were conducted unethically, not because the patient didn't consent, but because consent meant nothing. Prisoners, he pointed out, were unable to really give consent to anyone. There were also people who were told half-truths about the kind of treatment they would receive. In one study, patients were told that they would receive an infusion of cells, without being told that they were cancer cells. Sometimes, non-English speakers were asked to sign a consent form written in English. In all cases, the treatment the patients received did no good, and in some cases it endangered their lives.
Beecher argued that consent isn't enough. People needed to give informed consent. They needed to understand the risks of the treatment they were about to undergo, and they needed to be free to refuse that treatment. What's more, when it came to medical patients, the volunteers needed to expect some benefit from the medication. (Some of the people in the Beecher paper were actual patients seeking treatment for diseases, not volunteers for a study.) Although Beecher was criticized for cherry-picking the worst cases, for the most part the medical establishment and the public agreed with him.
As it turns out, Beecher may have known a little too much about human experimentation. In the early 2000s, evidence surfaced that he spent the 1950s and 1960s conducting CIA-sponsored experiments on humans in West Germany. People were drugged without their knowledge, and without real consent.
Read the Beecher paper here at Ethics and Clinical Research.
Image: Armin Kübelbeck.