Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case, and then we provide an expert's commentary.
Last week, you voted on how a student should handle her mentor's dark past in unethical research.
Confront her mentor: 53%
Report anonymously to the local paper: 2%
Report to university administrators: 12%
Include in her research paper: 7%
Ignore it: 26%
And now, bioethicist Jacob M. Appel, MD, JD, weighs in with an excerpt adapted from his book, .
Medical ethics and research norms are constantly evolving. Some of the profession's most illustrious figures have engaged in conduct that in hindsight is difficult to defend. For example, Jonas Salk, the celebrated inventor of the polio vaccine, previously took part in conducting controversial research that sprayed "wild influenza" into the nasal passages of psychiatric patients.
J. Marion Sims, the father of modern gynecology, earned his initial fame by performing experimental surgeries on enslaved unanesthetized African Americans. Experiments that went largely unremarked on at the time -- such as the notorious Tuskegee syphilis experiment (1932–1972), in which poor Black men were denied a treatment for their disease so that government researchers could watch its natural course -- now appear deeply unethical.
Only over the past few decades has medicine made a concerted effort to clear the historical record. For instance, diseases named for Nazi physicians Friedrich Wegener (1907–1990) and Hans Reiter (1881–1969) have recently been renamed, and a statue of Sims was removed from Central Park in 2018.
Contemporary society places considerable emphasis on the acknowledgment of past mistakes and often favors candor over retribution. One can see this phenomenon in the operation of "truth and reconciliation" in nations as varied as Argentina and South Africa.
Yet the revelation of a highly regarded figure's shady past not only damages that individual's image, but may also undermine the ability of that individual to champion worthwhile causes. For instance, revelations that German Nobel laureate Günter Grass served in the Waffen-SS during World War II led to what Grass's biographer called "the end of a moral institution" and the end of his authority to speak convincingly on behalf of human rights around the world.
The experiment in which "Van Helsing, MD," participated as a college student clearly defies modern ethical standards. But such experiments were all too common prior to the revolution in patients' rights that occurred in the 1960s and 1970s. Even if his involvement was minor, an argument can be made that history should judge his participation.
Emma may owe it to the children he sickened to reveal her discovery. Yet exposure would likely prevent Van Helsing from continuing his patient advocacy and human rights work. An argument can be made for forgoing justice for Van Helsing's past victims if doing so will help save present-day lives, but such a utilitarian approach may sit uneasily with many people.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases:
Withdraw Life-Saving Treatment if Siblings Can't Agree?