Dr. Kligman conducted experiments on humans who were in prison. Discuss in detai

Dr. Kligman conducted experiments on humans who were in prison. Discuss in detail one of the ethical principles from the textbook relevant to this situation. One of the major ethical principles that Dr. Klingman’s experiments on prisoners at the Holmesburg Prison violated was the Right to Freedom from Injury. According to ANA guidelines, “if there is a possibility of any potential injury that could occur, subjects need to know an estimate of the extent of such injury before giving their consent.” (Fain, 2017, p. 34) The benefits to the subject must outweigh the risk incurred, and it is clear that this was not the case. The film described the long-last injuries sustained by test subjects, including exposure to toxic chemicals, radioactivity, and persistent pathogens. To willingly take on these risks means test subjects were either very intent on helping advance scientific knowledge (unlikely) or felt like they had few other options.
The major benefit to prisoners was that they earned compensation, which was higher compared to other prisons conducting research. However, this was taking advantage of desperate conditions. According to Russell Green, a former Holmesburg prisoner and test subject, money was a form of protection from violence at the prison, and most prisoners were impoverished. Becoming a research test subject was partially done out of a need for survival, making this a vulnerable group. The racial makeup of the prisoner population also added another layer of vulnerability to the population. While I was unable to find statistics about the racial makeup of the prison at the time, the film confirmed that the majority of prisoners at the time were Black. This is aligned with well-known research that most U.S. prisoners are disproportionately Black and then Latino, as written in The New Jim Crow by Michelle Alexander. This rings true today – of December 2021, about 74% of Philadelphia prisoners are Black (City of Philadelphia, 2021). The minority makeup of the prison population means there is a lot of room for unconscious as well as explicit bias. According to Implicit Association Test results from 2002 to 2017, 75% of participants had an unconscious preference towards White people. (Marcelin et al., 2019). This means that healthcare needs of white people are often taken more seriously than of ethnic minorities. Racial health disparity studies have shown time and time again that Black pain is not taken as seriously in healthcare settings (Akinlade, 2020). Dr. Kligman himself felt like a “farmer seeing a fertile field for the first time”, which goes beyond being a “crazy scientist” – it is dehumanizing, which has been the historical treatment of minorities in this country.
This is a one-sided, biased story of abuse, moral indifference and greed. There is always the other side. As a nurse who understands the parts of a research study and the related research ethics, what further information would you like to know to make an impartial and fair-minded decision about this ethical situation?
I would like to know if prisoners were given the option to exit the study at various points. According to section 9 of the Nuremberg Code, “During the course of the treatment, the human subject should be able to bring the experiment to an end” (Fain, 2017, p. 30). Did prisoners feel forced to continue the research after sustaining these injuries, or were they presented with the option to stop? When conducting research on human subjects, there are always risks and benefits. Can you imagine a time in which yourself or a family member might choose to take part in an experimental treatment for which the risks/benefits are not known? Put yourself into that person’s shoes and describe your feelings in one paragraph. A situation I can imagine is a loved one being in a clinical trial for a neurodegenerative disease like Alzheimer’s. There would be both tremendous hope that treatment would delay degeneration, and fear that the patient would be subjected to serious adverse effects despite the best scientific research beforehand.
In your opinion, should prisoners now be allowed to become research subjects while in prison? A) Why, and B) why not? (Be sure to fully discuss both aspects.)
A) Besides an opportunity for financial compensation, participating in research could provide a means of intellectual stimulation for the prisoner population. Research has shown that prisoners who fully complete GED programs, vocational training, and other educational endeavors had lower rates of recidivism (return to prison) 2-3 years after release compared to those who did not complete an educational program (Pompoco, 2017). B) Prisoners do not have the same degree of access to information as a non-incarcerated individual does. For example, they do not have phones or computers where they can learn more about the research being conducted. They cannot conduct a simple Google search to learn more about the subject at hand, or even look up terminology that they do not understand. Therefore, they have to fully rely on the information (or misinformation) being given to them by authority figures and fellow inmates in order to make a decision to participate. This adds another layer of vulnerability.
References:
Akinlade, O. (2020). Taking black pain seriously. New England Journal of Medicine, 383(10). https://doi.org/10.1056/nejmpv2024759 City of Philadelphia. (2021, December). Philadelphia Prison Population Report | July 2015 – December 2021 . Philadelphia prison population snapshot reports. Retrieved January 27, 2022, from https://www.phila.gov/media/20220121105102/Full-Public-Prison-Report-December-2021.pdf
Fain, J. A. (2017). Reading, understanding, and applying nursing research. F.A. Davis Company. Marcelin, J. R., Siraj, D. S., Victor, R., Kotadia, S., & Maldonado, Y. A. (2019). The impact of unconscious bias in healthcare: How to recognize and mitigate it. The Journal of Infectious Diseases, 220(Supplement_2). https://doi.org/10.1093/infdis/jiz214 Pompoco, A., Wooldredge, J., Lugo, M., Sullivan, C., & Latessa, E. J. (2017). Reducing inmate misconduct and prison returns with facility education programs. Criminology & Public Policy, 16(2), 515–547. https://doi.org/10.1111/1745-9133.12290 From Dr.Kligman’s research on incarcerated humans, one can see that there is a dark history of unethical human testing. I want to highlight the ethical principle of fair subject selection (Fain, 2021). According to the NIH, fair subject selection is one where the primary choice is solely based on the scientific goals of the study- not vulnerability, privilege, or other factors unrelated to the study (U.S. Department of Health and Human Services, n.d.). Dr. Kligman did not follow this ethical principle when selecting his experimental group. The prison population is a vulnerable community at risk of exploitation, mainly because they lack autonomy. According to the NIH, “federal regulations on research involving human participants designate prisoners as a ‘vulnerable population’ and require that special protections be afforded to them”(Smoyer et al., 2009). Since, the NIH has implemented that all grant applications must have a “Protection of Human Subjects” section that outlines the experiment’s potential risks and benefits.
I would like to know if informed consent was provided and accessible to all illiterate and non-English speaking inmates. It is essential that all efforts are made to obtain informed consent and that all the protocols are listed clearly. According to the Belmont Report, which establishes the ethical principles that underlie the conduct of research, respect for persons is an essential principle that all studies should follow. This principle states that “people are autonomous agents and have the right to decide for themselves whether they want to participate in a research study” (Sims, 2010). Because incarcerated people have restricted autonomy in every aspect of their life, can they truly give informed consent? Also, how can we ensure that those who are incarcerated are not at a higher risk of harm than those out in the community? Further research would need to be done to ensure that these questions are answered before conducting safe experimentation on the vulnerable prison population.
I participated in a research study as an undergraduate student because I was compensated. As a student at the university where I did the study, I did not concern myself with the risks. But, of course, the research study I took part in was not as extreme as the Kligman study, and as a young college student, I felt like I could not harm myself. Putting myself in their shoes, I can see why an incarcerated person may want to participate in an experiment like this. Christopher et al. (2017) explain how the inmates were motivated by a desire for financial compensation, a belief that participation would lead to favorable treatment from prison authorities, and insulation from prison violence. Especially being in an environment where staff, outside communities, and even medical professionals see you as less than human, I can see what motivated the inmates. They may have felt they had access to care by participating in these experiments or felt they were a part of the greater community by helping advance research.
I do not believe that prisoners should be allowed to become research subjects while in prison. Especially when there are unanswered questions, such as if incarcerated people are more at risk of harm than nonincarcerated people, I do not think that research can be conducted on prisoners safely. On the other hand, I believe that every person should be able to decide whether or not they want to participate in a research study. Possibly, if there is a research study that clearly outlines that the benefits outweigh the risks, such as being able to combat health disparities between prisoners and the general public, and the investigation is relevant to groups in prison, then it may be plausible. However, until we know that these vulnerable populations can be protected, I am afraid that history will repeat itself. Christopher, P. P., Garcia-Sampson, L. G., Stein, M., Johnson, J., Rich, J., & Lidz, C. (2017). Enrolling in Clinical Research While Incarcerated: What Influences Participants’ Decisions?. The Hastings Center report, 47(2), 21–29. https://doi.org/10.1002/hast.686
Hornblum, A. M., & Holmes, G. J. (Producers and Directors). (2004). Acres of skin: Medical abuse behind bars [Motion picture]. United States: Films Media Group.
Sims, Jennifer M. MSN, RN, ARNP, CCRN A Brief Review of the Belmont Report, Dimensions of Critical Care Nursing: July 2010 – Volume 29 – Issue 4 – p 173-174
doi: 10.1097/DCC.0b013e3181de9ec5
Smoyer, A. B., Blankenship, K. M., & Belt, B. (2009). Compensation for incarcerated research participants: diverse state policies suggest a new research agenda. American journal of public health, 99(10), 1746–1752. https://doi.org/10.2105/AJPH.2008.148726
U.S. Department of Health and Human Services. (n.d.). Ethics in clinical research. NIH Clinical Center. Retrieved July 4, 2022, from https://clinicalcenter.nih.gov/recruit/ethics.html#3