No Informed Consent to the State

Who knew I'd come to feel a kinship with the men of the Tuskegee Syphilis Study? Some may think it presumptuous for a middle-aged, professional white woman to identify with the victims of state experimentation as horrific as letting men die — after spreading the infection to their wives and children — of a terrible and easily-treatable disease, but I don't think it is at all an exaggeration to say that we all are victims of the government's continuing insistence on doing ill in the name of good. Let me explain…

I do brain-imaging research with human subjects, and I recently had occasion to review the subject consent forms we use to inform subjects about the study they are enrolling in and to obtain their informed consent to participate in the study. We have separate forms for research consent on healthy adult subjects, healthy children, parents of healthy children, healthy adults, and a whole matched set for affected (diseased) individuals. On the forms, the experimental procedures are carefully described, the benefits to the patient and to research efforts are outlined, and possible complications and dangers are described as specifically as possible. All these forms have as their historical background the terrible failures of human research which were outlined for me as part of my early training for working with human subjects. Nazi experimentation, the Tuskegee and Willowbrook studies, and human radiation experiments during the period of 1944–1974, along with other research fiascos, all combined to convince institutions that a careful consent-based approach, which provided as much information to the subjects as possible and required their informed approval, was called for. Note that most of these tragedies were the result of state, not private, actions.

The last observation in the preceding paragraph isn’t just an aside — it is at the heart of the matter. Because of the power of the monopoly state, only concerted action from outside or from powerful forces within can bring it to heel on such awful abuses of power as human experimentation. This was brought home to me by a commentary I heard while listening to PRI’s Marketplace radio program last week. Sol Gellerman — one of their commentator-contributors — was lamenting the failure of tax credits for companies which provide their employees with stock options to increase employee loyalty. Mr. Gellerman wasn’t pointing out the essential wrongness of the state trying to influence behavior in a Skinnerian carrot-and-stick fashion (with a carrot it swiped from the subjects in the first place!), but only the more mundane fact that in this case the carrot hadn’t been large enough or sweet enough to accomplish the task of changing employee behavior.

What most caught my attention, though, was Gellerman’s characterization of this government meddling as ‘experimentation’. Gellerman even made an explicit comparison to a previous attempt at social engineering – prohibition – as yet another ‘failed experiment’. The final straw for me was his description of these disasters as ‘noble experiments’.

Unwittingly perhaps, Mr. Gellerman touched on the essence of state social engineering – and why it is so wrong. It is experimentation – on that point he is absolutely correct. But can experiments performed on humans without the informed consent of the ‘subjects’ be anything but wrong? To say that these experiments are performed by u2018society' is meaningless — no matter how big Mr. Greenspan's head becomes, it will never encompass all of society. These u2018noble experiments' — tax breaks, prohibitions, sin taxes, incentives, disincentives, social security, etc. — are individual actions taken deliberately by individuals acting through the monopoly control of the state. These individuals are as guilty as any Nazi doctor who tested a new gas on human prisoners.

Likewise, it is as ridiculous to speak of social tinkering as being performed on u2018society' or u2018the economy' as it is to speak of u2018society' performing the experiments. Societies are nothing but collections of individuals, and each individual has the right to participate (or not) in any particular design or u2018experiment' dreamed up by a hopeful social engineer. The very catchphrase u2018social contract' — used to justify the actions of a few taken in the name of all — gives away the truth that those who perpetrate their experiments on others are perfectly aware that consent is needed to morally justify their games. They seek a shallow sort of self-justification or thin cloak for their crimes by calling them by the exact opposite of what they actually are. The so-called u2018social contract' is no more a contract than a turtledove is a terrestrial reptile.

In my research, the process of explaining the study to potential subjects and getting their informed agreement to be included in the study is often referred to as u2018consenting the subject'. The men in the Tuskegee subject were never properly u2018consented', and that, as much as the fact that the experiment happened to go horribly wrong, is the evil which was done to them. That same evil is being done to each and all of us every day by the amateur social scientists filling our legislatures. They offer up u2018cures', one after another, for all sorts of social ills — many of their own making — and as each one fails to help or sets off a cascade of new ills (each needing a new u2018cure'), they offer nothing but more experiments, more untried poison pills of their own concoction, and nothing else but a locked door to anyone trying to get out of the laboratory.

October 31, 2002