Case Application: TUSKEGEE STUDY Syphilis is a chronic, contagious bacterial disease that is most often sexually transmitted but is sometimes congenital. Since about 1946, the disease has been successfully treated with antibiotics. Prior to 1946, individuals with the disease had an inevitable progress through its sequelae, from the primary lesion and chancre to rash, fever and swollen lymph notes to the final stage of nervous system and and circulatory problem, and finally death. The progress of the disease is often 30-40 years. Around 1929 there were several counties in the South, with a high incidence of syphilis. The U.S. Public Health Service (USPHS) began a demonstration project to treat those afflicted with the disease in Macon County, Alabama, home of the famous Tuskegee Institute. With the Great Depression, funding for the project decreased and finally the demonstration project to treat the men became an opportunity for a study in nature. A study in nature means that the researchers were not to treat the patients rather were to observe the natural progression of the disease. To conduct this study in nature, the USPHS selected 399 African American men who had never received treatment. The research group was told essentially that they had "bad blood" and they had been selected for special free treatment. Except for an African American nurse, Eunice Rivers, there was very little continuity with staffing of the experiment, as the federal doctors would come every few years to check on the progress of the disease. To induce the participants, they were, promised free transportation, free hot lunches, free medicine (for everything but syphilis), and free burials. Although antibiotics were available in adequate supply by 1946, the study subjects were never treated. In fact, the local draft board was provided their names so that they could not enter the army, where they would have been treated as a matter of course. The local members of the county Medical Society were also provided their names and were asked not to provide them with antibiotics. In July 1972, Peter Buxtun of the USPHS, who had been criticizing the study since 1966, told the story to an Associated Press reporter, and the research became headlines across the nation. In 1997, President Clinton officially apologized to the remaining study participants in behalf of the United States government. Answer the question: Consider each of the individual basic ethical principles: autonomy, veracity, beneficence, non- maleficence, justice, fidelity and confidentiality. Which of these principles were sacrificed or violated in the Tuskegee study? (Give at least 3 ethical principles). Explain the answer