Present Lessons from Past Infractions: STD Research in Guatemala in the 1940s as an Ethics Case Study

Abstract

The case study of sexually transmitted infection (STI) research conducted by the U.S. Public Health Service (PHS) in Guatemala from 1946-48 is an excellent teaching tool for ethics education. By providing insight into the complexity of the ethical infractions that allowed the Guatemala experiments to occur, this case study helps to integrate four central lessons into an ethics course: (1) casuistry as a form of ethical analysis, (2) the complexities of research with vulnerable populations, (3) the ethical values embedded in current regulatory oversight and external review, and (4) the conceptual and practical difficulties of assigning shared responsibility and culpability. Designed with the intention to assist educators experienced and new, this article examines how educators can explore the contours of current research contexts through an introduction to casuistry, and ask students to translate their understanding of the Guatemala case into lessons for present research practices.

The findings and conclusions in this Article are those of the authors and do not necessarily represent the official position of the Presidential Commission for the Study of Bioethical Issues or the Department of Health and Human Services.

Keywords: Guatemala and STD; Guatemala and STI; teaching ethics; research ethics; casuistry; case study; public health ethics