Ethical Issues
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The medical community was not morally or ethically prepared to handle the modern challenges of the rapidly increasing number of scientific advancements and technological developments in medicine. While medical ethics have existed since the time of Hippocrates, the physician was seen as the only one with medical education, training, and experience, and the recommendations of the physician were not questioned, a practice often called paternalism. Although the Hippocratic Oath contained no mention of patient desires for medical treatment (Simon, 2014), the goal of medicine has always been to provide treatment in the best interests of the patient, and it was the physician who was responsible for the medical welfare of the patient (Beauchamp & Childress, 2013).
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Paternalism focused on established medical ethics principles of beneficence (to do good) and non-maleficence (to do no harm) without any discussion of autonomy (Simon, 2014). As autonomy developed in the Western world and values shifted toward personal responsibility and individuality, the concept of self-determination in medical decision-making became more important to society (Simon, 2014). Unethical research studies, both at home and abroad, along with prominent legal cases were now in the general public’s limelight. Discussions began to focus on informed consent and the patient’s right to accept, refuse, or withdraw medical treatment recommendations (Brown, 2003). Medical ethics principles now included beneficence, non-maleficence, respect for autonomy, and justice (Beauchamp & Childress, 2013; Gwyther, 2011). These principles were identified in the 1979 Belmont Report as the basic ethical principles upon which to interpret and answer difficult ethical questions such as those posed by advances and developments in science, medicine, and technology (U.S. Department of Health, Education, and Welfare [DHEW], 1979). The Belmont Report, by way of the 1974 National Research Act, resulted from the public disclosure of the U.S. sanctioned Department of Public Health Tuskegee Syphilis Study in which autonomy and informed consent were of little or no importance. Sadly, the right to self-determination and autonomous decision-making had already been highlighted in both the 1949 Nuremberg Code (U.S. Department of Health and Human Services [DHHS], 1949) and the 1964 Declaration of Helsinki (World Medical Association [WMA], 2018), yet never implemented in the Tuskegee Study.