In many ways, Henry K. Beecher was a paradox. His early education and training gave little hint of an interest in ethics.
Although he changed his name from Unangst to Beecher (perhaps to be associated with two 19th century icons), he also helped the CIA conduct unethical experiments on prisoners. During the late 1950s, however, he underwent a revolution in thinking and began to explore the basic ethics behind research on humans.
Beecher Focuses on the Ethics of Human Experimentation
On February 10, 1958, Beecher delivered an address on research ethics before the Executive Committee of the Committee on Research at Harvard University. According to Kopp (1999), Beecher lamented that “no review has heretofore been made which attempted to deal with all facets” of human experimentation abuses. Nevertheless, he admitted that “a great deal can be done to correct nearly all abuses by disseminating information on past experience and thinking in this complicated field.”
Beecher later repeated his thoughts in a letter to the Dean of Harvard Medical School. There is no record of how his address (or letter) was received, but it can be assumed that fellow researchers would not have taken kindly to criticism about any of their possible "abuses."
Beecher Publishes "Experimentation in Man"
Throughout 1958, Beecher began reflecting on the history of human experimentation. He wondered how medical research had evolved to the point where abuses seemed more common than not, and spent hours studying the subject before putting his thoughts down on paper.
The result of his efforts was published in 1959 as “Experimentation in Man.” This lengthy article attempted to distinguish between ethical and unethical experimentation on humans. Beecher began by giving an overview of research on humans from ancient Persia through his own time, and then argued how research was “essential for the welfare of the race.”
Beecher also discussed possible sources for research subjects. In general, he believed that research should be conducted first on informed personnel with an interest in science, which would initially limit experiments to graduate students, laboratory employees, and medical students. When those avenues of recruitment were exhausted, researchers should then turn to individuals who owed a debt to society, such as prisoners and conscientious objectors to military service.
Are Codes of Regulation Useful?
Somewhat surprisingly, Beecher (1959) claimed that codes of regulation were useless. He felt that legal rules would likely do more “harm than good,” as rules were “not going to curb the unscrupulous.” Beecher believed that human experimentation abuses occurred “due to ignorance and inexperience,” and not willful misconduct. Only by “understanding...the various aspects of the problem” could the “the broad gap between the law of the land and...morally sanctioned experimentation in man...be narrowed.” How this gap was to be narrowed, though, Beecher did not say.
At first glance, Beecher's opinions here seem to contradict his later work, including his landmark 1966 article on “Ethics and Clinical Research.” In fact, however, the views expressed are consistent with his philosophy. Beecher always was more interested in identifying moral lapses than the sources of the lapse – in protesting unethical abuses while, at the same time, offering excuses on behalf of the abusers. There was a peculiar dichotomy in the man, as well as an ambivalent attitude toward the deeds he was condemning.
Beecher and Informed Consent
In general, Beecher put more faith in physicians adhering to the Hippocratic Oath than he did with the 10 principles of the Nuremberg Code (1947), which he felt were almost impossible to follow. His comments on informed consent are a case in point. Beecher (1959) believed that informed consent was “often quite impossible” to achieve because the “the complexities of essential medical research...are often not really communicable to lay subjects.”
At best, Beecher’s arguments are special pleadings why unethical conduct occurs. In fact, Beecher claimed that most investigators would obey the Nuremberg Code “if they always knew how.” Even today, it is unsettling to hear arguments why physicians not only are unable to understand all the implications of complicated medical research, but also how they should be forgiven for not knowing how to comply with ethical standards set forth in 1947 as a consequence of National Socialist (Nazi) medical experimentation abuses.
Beecher's Article Fails to Attract Public Attention
Although the initial response to his article was positive, it failed to achieve the public attention Beecher felt the subject deserved. Over the next several years, Beecher would continue to submit articles on informed consent, ethics, and clinical experimentation to journals such as Clinical Pharmacology & Therapeutics and JAMA. It would take seven years before his views would receive the attention he desired.
References
Beecher HK. 1959. Experimentation in man. JAMA. 169:461–478.
Kopp VJ. 1999. Henry K. Beecher, M.D.: contrarian (1904–1976). ASA Newsletter. 63(9):September.
 |
