___________________________________________ DCA05DE Dental Ethics and the Digital Age, 3rd Edition
Code ( Text Box 2 ) emerged as the first document to state the moral obligation of researchers to conduct legitimate research and protect human subjects who participate. Before this time, there had been no written or widely accepted standards for protecting human subjects in research, even when they con- sented to take part. While research atrocities were occurring in Europe, the United States was not immune to transgressions of its own. For 40 years, from 1932 to 1972, the U.S. Public Health Service con- ducted the Tuskegee Syphilis Study, enrolling approximately 600 African American men in the program. Because no cure for syphilis existed at the inception of the study, the purpose of the Tuskegee research was to observe the natural progression of the disease. However, even when penicillin became available in the 1940s, researchers never gave the drug to participants in the study. In fact, they never informed the subjects that syphilis was their diagnosis, telling them instead that they had “bad blood.” Therefore, the participants could not seek treatment for syphilis on their own (Centers for Disease Control and Prevention (CDC), 2022; Tuskegee University, 2021).
Healthcare Consideration The Hippocratic Oath remains a foundational ethical guide in healthcare, emphasizing the principles of “do no harm,” patient confidentiality, and the importance of professional integrity. While modernized to reflect contemporary medical practice, its core values continue to shape the moral respon- sibilities of healthcare providers, ensuring patient-centered care and trust in the profession. The years between 1940 and 1985 mark an important period in the development of medical and dental ethics worldwide. The atrocities that occurred in the concentration camps during World War II sparked this era of change. The Nazis designed a plethora of “research studies” that involved the torture and murder of concentration camp inmates. Historians have thoroughly documented the complete disre- gard for basic human rights that characterized some of the “research studies” performed in the camps by Joseph Mengele and others. As a result of these experiments, the physicians were put on trial in Nuremberg, Germany, and the Nuremberg
BOX 2: THE NUREMBERG CODE 1. The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved, as to enable him to make an understanding and enlightened decision. This latter element requires that, before the acceptance of an affirmative decision by the experimental subject, there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person, which may possibly come from his participation in the experiment. The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs, or engages in the experiment. It is a personal duty and responsibility, which may not be delegated to another with impunity. 2. The experiment should be such as to yield fruitful results for the good of society, unprocurable by other methods or means of study, and not random and unnecessary in nature. 3. The experiment should be so designed and based on the results of animal experimentation and a knowledge of the natural history of the disease or other problem under study that the anticipated results will justify the performance of the experiment. 4. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury. 5. No experiment should be conducted, where there is an appropriate reason to believe that death or disabling injury will occur, except, perhaps, in those experiments where the experimental physicians also serve as subjects. 6. The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment. 7. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death. 8. The experiment should be conducted only by scientifically qualified persons. The highest degree of skill and care should be required through all stages of the experiment of those who conduct or engage in the experiment. 9. During the course of the experiment, the human subject should be at liberty to bring the experiment to an end, if he has reached the physical or mental state, where continuation of the experiment seemed to him to be impossible. 10. During the course of the experiment, the scientist in charge must be prepared to terminate the experiment at any stage if he has probable cause to believe, in the exercise of the good faith, superior skill and careful judgment required of him, that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject. Source: Note. U.S. Department of Health and Human Services. (2024 [1949]). The Nuremberg Code. In Trials of War Criminals Before the Nuremberg Military Tribunals Under Control Council Law No. 10 (Vol. 2). Washington, DC: U.S. Government Printing Office. Retrieved from https://www.hhs.gov/ohrp/international/ethical-codes-and-research-standards/index.html. Box 2
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