Medical research conducted on prisoners in this country was banned in 1976 and is now regulated by 45 CFR 46 (Subpart C). Although many factors make prisons unlikely places for the ethical conduct of human research, the fact that prisoners have less autonomy to make basic decisions about their lives renders them vulnerable to coercion and other forms of abuse. For example, prisoners might be willing to accept undue risks in exchange for small incentives (a change of scenery, something to do) or prisoners might see participation as a potential way of shortening their sentence (“good behavior”). Thus, in such an environment, research subjects might willingly consent and even actively participate in research, but do so at great costs and for the wrong reasons.
In a recent article published in Studies in History and Philosophy of Biological and Biomedical Sciences, Nathaniel Comfort examines such a case in “The prisoner as model organism: malaria research at Stateville Penitentiary”. Beginning in the1940s (in the middle of the Second World War), the U.S. military funded and conducted research on malaria in Illinois’s Stateville Penitentiary. Given that malaria seriously weakened the U.S. forces, the push for better and more readily available malaria remedies was considered a matter of national security and patriotic devotion. The military did not want to recruit healthy soldiers into risky medical experiments. The prison population, therefore, provided a convenient alternative. The inmates lived in a controlled setting and, as Comfort recounts, they were eager to participate. (In the first day of a call for 200 volunteers, 487 inmates responded.) Furthermore, the prisoners participated in the experiments at all levels. They served as research subjects (receiving variously potent and toxic treatments for malaria), reagents (facilitating recruitment, conducting lab work, and reporting results), and even as research objects (the mosquitoes needed something to eat and the virulent Chesson-strain of Plasmodium vivax needed human hosts).
Comfort explores the subtle and not-so-subtle ways that the prison/research system transformed the inmates into “model organisms”. He relies on the accounts of a doctor, Ernest Beutler, and a prisoner, Nathan Leopold (of the “Leopold and Loeb” duo). Beutler remembered that it felt like working in a hospital and that the prisoners “really were volunteers”; but Leopold (who had two heart attacks during the research and later died of heart failure) boasted, “No man was coerced or even persuaded … Every man who went on the project at Stateville did so because he wanted to, almost because he insisted on it.” As for the public … the research was anything but secretive, Life magazine ran a photo essay on the work in 1945 and another on Leopold in 1957, radio stations interviewed the prisoners, and, according to Comfort, the prisoners “became something of heroes; their sacrifices for the war effort were celebrated … the project’s ethical lapses were hidden in plain sight, and its morally therapeutic qualities were stressed”. At Stateville, the line between biomedical research and criminal punishment (or “rehabilitation”) blurred. As Comfort writes, “The suffering the prisoners would endure would be counted as part of their punishment, would be credited against their debt to society”. With a cooperative, but not truly autonomous, population at hand, the doctors, the military, the prison, and the public supported a project which ran counter to the (yet to be adopted) Nuremberg Code. Clearly, as at Stateville Penitentiary, willing participants, noble causes, and even a supportive public are not sufficient markers of an ethically conducted research study.
Comfort N. The prisoner as model organism: malaria research at Stateville Penitentiary. Stud Hist Philos Biol Biomed Sci. 2009 Sep;40(3):190-203. PubMed PMID: 19720327
45 CFR 46 (Subpart C). Additional protections pertaining to biomedical and behavioral research involving prisoners as subjects. Available from: http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm#subpartc
Advisory Committee on Human Radiation Experiments. Prisoners: a captive research population. In The Final Report of the Advisory Committee on Human Radiation Experiments. Available from: http://www.hss.energy.gov/HealthSafety/ohre/roadmap/achre/chap9.html
Chwang E. Against risk-benefit review of prisoner research. Bioethics. 2010 Jan;24(1):14-22. PubMed PMID: 20017743.
Elger BS, Spaulding A. Research on prisoners – a comparison between the IOM Committee recommendations (2006) and European regulations. Bioethics. 2010 Jan;24(1):1-13. PubMed PMID: 20017742.
Elger BS. Research involving prisoners: consensus and controversies in international and European regulations. Bioethics. 2008 May;22(4):224-38. PubMed PMID: 18405321.
Gostin, Lawrence O., Cori Vanchieri, and Andrew MacPherson Pope. Ethical considerations for research involving prisoners. Washington, D.C.: National Academies Press, 2007. Available from: http://www.nap.edu/catalog.php?record_id=11692
Smoyer A, Belt B. Compensation for incarcerated research subjects: a state-by-state analysis. Center for Interdisciplinary Research on AIDS (CIRA), Yale University; 2008. Available from: http://cira.med.yale.edu/law_policy_ethics/cfirs_asbsa.pdf
Thomas DL. Prisoner research – looking back or looking forward? Bioethics. 2010 Jan;24(1):23-6. PubMed PMID: 20017744.