Conclusions and Recommendations, Report by the Guatemalan Presidential Commission, Comisión Presidencial para el Esclarecimiento de los Experimentos Practicados con Humanos en Guatemala, Consentir el Daño: Experimentos Médicos de Estados Unidos en Guatemala (October 2011). Siga este enlace para español.
By Dr. Rafael Espada
Vicepresidente de la República
Presidente y Coordinador de la Comisión Presidencial para el Esclarecimiento de los Experimentos Practicados con Humanos en Guatemala durante el periodo de 1946 – 1948
Conclusions and Recommendations at pages 18-20.
- The human experimentation conducted in Guatemala during the years 1946 to 1948 is a violent transgression against the dignity of defenseless people, the medical profession and the sovereignty of the nation, as well as ethics in scientific research. It is an immoral act of great impact and a crime against humanity.
- With the victims in Guatemala the following principles were violated: beneficence, by failing to provide a useful treatment; autonomy, in keeping them ignorant of the fact that useful treatment existed; and justice, because a vulnerable population was involved, that was traditionally discriminated against and seen as inferior, and that lacked adequate education to make a judgment. To make matters worse, the principle of “do no harm” was violated in provoking harm through the inoculation of harmful substances (syphilis, gonorrhea and chancroid).
- Those who are fundamentally responsible are the investigators and the key institutions that supported them, the Public Health Service of the United States and the World Health Organization. Investigators (John Cutler and his colleagues) are recognized as responsible, because as available archival records show, they were well aware that what they were doing was a grave violation of medical and research ethics. Also responsible, at the same time, are the Guatemalan doctors with varying degrees of authority in the public sphere, who induced and facilitated the “human material” for the experiments and institutional cover up.
- Three factors involving the context explain the violation, (a) the weakness of the Nation, material backwardness, and the dependency and subordination of the country, (b) the subordinate relationship of the Guatemalan doctors to their U.S. colleagues and (c) the strong structure of exclusion, marginalization, racism and discrimination in Guatemala, which is reproduced in educated classes, such as the professional classes. All these factors are still present in Guatemala, providing the stage in which similar cases could recur.
- An action that cannot be delayed is to continue the identification process, both of victims who are deceased and who are still alive, and their relatives and descendants. It is necessary to establish the impact that the experiments had in their lives and from that knowledge to develop mechanisms for economic and social compensation.
- This offense against the national dignity can not be left with the offer of an apology, the process for reparation should be developed for the victims affected by the action and inaction of the Nation, and for the Nation itself.
- Necessary and effective measures should be established so that actions like these experiments do not occur again; it is necessary to revise the legislation and the regulatory body that regulates research in Guatemala. It is necessary to clarify whether these regulations are adequate to comply with ethical standards of research.
- Diagnostics and reflections on how to organize the current health system in Guatemala, must be accompanied by proposals for the creation of independent entities with binding authority to monitor and enforce regulations in the research process.
- Finally, it is recommended that this investigation and the Presidential Commission for Elucidation [Comisión Presidencial de Esclarecimiento] be continued to generate a culture of accountability, while promoting independent studies by the Nation in order to create balance, and avoiding conflicts of interest.
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Chapter VII from the Report Consentir el Daño by the Presidential Commission
CONCLUSIONS AND RECOMMENDATIONS at pages 96-99.
1. Final Considerations
1.1 A comparative study of the documents that were remitted by the Government of the United States to Guatemala and documents located in the National Archives confirms the facts disseminated in the last months of 2010, when information was made public about the experiments conducted in our country by doctors from the United States of America, in cooperation with doctors and officials from the Ministry of Health of Guatemala, where a large number of women and men were subjected to inhuman clinical procedures related to venereal diseases.
1.2 The analysis of the economic, political and social situation in Guatemala when the experiments were performed, makes evident the weakness and precariousness of Guatemalan institutions of the time, which were responsible for ensuring the defense of sovereignty, human rights and dignity of the population.
1.3 According to information confirmed in the documents reviewed, it can be confirmed that the experiments with inoculation and infection of syphilis, gonorrhea and chancroid, directly affected at least 2,082 Guatemalan women and men, including hospital patients, prisoners, soldiers and sex workers. The documentary information indicates a greater number of victims that cannot be determined with certainty and exactitude.
1.4 On the basis of the documents examined, there exists no evidence to indicate or suggest that persons subject to inoculations and other experimental methods, were informed, consulted or warned about these experiments and the consequences that the methods had or may have had for their health. This is even more grave in the case of neuropsychiatric hospital patients who were intentionally used by taking advantage of their condition.
1.5 The ability and opportunity for deliberation, protest, and opposition by the persons and groups who were victims of the experiments — mental patients, prisoners, soldiers and sex workers — was non-existent or extremely limited. The exercise of their individual rights depended on the will and interests of the authorities who exercised power over them. In all cases there was an extreme level of subordination and vulnerability.
1.6 The detailed records of the victims of the experiments establish that the majority of the people were exposed, in a cruel and inhuman way, to venereal disease causing severe harm to their bodily health [organismos, organisms] and even death. The physicians responsible left a written record of the conscious awareness of the incalculable harm that the experiments could cause to the victims. The experimental procedures involved pain and physical and mental suffering by the victims.
1.7 Racism, with its weight of prejudice, contempt and discrimination, was present throughout the entire process of the experiments, in an explicit and conscious way. This constitutes an aggravating factor against the victims and the dignity of the country.
1.8 These experiments conducted on human beings constituted a flagrant violation, conscious and deliberate, of the fundamental rights to health, life and the protection of the person, as well as the bioethical principles of DO NO HARM [NO MALEFICENCIA, no wrongdoing], with the inoculation of a harmful “substance.” Regarding INFORMED CONSENT, it was not explained to them, and they were not asked for their consent. Regarding DELIBERATE EXPOSURE TO DISEASE, it is not ethical or lawful to cause patient harm.
1.9 The documents identify at least 10 Guatemalan doctors and a number of doctors from the United States directly involved and consciously aware in the experiments. Similarly, the archival records manifest consent, collaboration and in many cases servility by Guatemalan authorities at an intermediate level in the field of public health. The documents show the deliberate intention of those responsible for the experiments to hide data and misinform higher authorities of the time.
1.10 The human experiments were conducted in Guatemala while the Nuremberg tribunals were trying the Nazi regime for similar practices, about which the world press offered extensive information. These inhuman medical practices were perpetrated in our country just as the concert of nations disseminated the Nuremberg Code and the concept of crimes against humanity.
1.11 The experiments described above were performed under the direction of the Public Health Service of the United States through the Venereal Disease Research Laboratory (VDRL) and the Surgeon General (SG) units of which the physicians responsible for the experiments were members, and which constituted pubic state entities of the government of the United States of America. The same is true for the Pan American Health Organization (Oficina Sanitaria Panamericana (OSP)). None of the U.S. doctors and officials involved acted on their own account but by superior orders pursuant to an official policy of the era that prevailed [influía] in Latin America.
1. Identify survivors and relatives of the persons affected.
2. Establish the impact that the experiments had on their lives from medical, social, economic and psychological perspectives.
3. Establish mechanisms for institutional and individual reparation and compensation on the part of both governments, for those affected by the action of officials of the agencies involved.
4. Revise laws governing scientific research in Guatemala to ensure compliance with ethical standards of international research and to prevent violations of national sovereignty.
5. Promote state policy and strengthen the National Council of Science and Technology to implement mechanisms to monitor and regulate scientific investigations, with particular emphasis on bioethics, based on the principles of human dignity and equality.
6. Strengthen compliance with the constitutional requirements of equality among human beings, combating discrimination, especially racism, in all sectors of Guatemalan society.
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(1) Click here for the complete report by the Guatemalan Presidential Commission Consentir el Daño in Spanish.
There are two additional reports in Spanish, which provide background for the report by the Guatemalan Presidential Commission.
(2) Click here for the archival report Investigación archivística sobre experimentos practicados en seres humanos en Guatemala, 1947-1948 (Mayo 2011) by Archivo General de Centro América (AGCA), el Archivo Histórico de la Policía Nacional (AHPN), y la Dirección de los Archivos de la Paz (DAP) de la Secretaría de la Paz.
(3) Click here for the technial report, Experimentos en Seres Humanos: el Caso Guatemala 1946-48 (Abril 2011), by Comisión Técnica, Comisión Presidencial para el Esclarecimiento de los Experimentos en Humanos en Guatemala 1946-48.
These reports are not available in English. The U.S. Presidential Commission on Biotethics should publish these reports in English to ensure the Guatemalan perspectives are included to ensure justice for Guatemalan people in the STD atrocities.
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