Studies in the Behavioral Sciences to establish an integrated program of technology assessment, which will take into account the societal impacts of current and future developments in medicine and biology. The NSF expects that, as a result of these studies, there will be a more active concern within the academic community for the value questions associated with science research, and additional studies in the sciences and humanities.

It is also anticipated that within the next one to two years NSF-supported research will yield a major conceptual assessment and significant research plans for further work in societal impacts of biological and medical technology.

In the private sector, several distinguished groups already in existence have broad responsibilities in the areas outlined for the proposed Commission on Health Science and Society. These include the National Academy of Sciences, with its newly established Institute of Medicine, and its National Research Council; the American College of Surgeons; the National Academy of Engineering; the American Academy of Arts and Sciences; and the American Philosophical Society. These prestigious organizations have taken very seriously the legal, social, and ethical implications of advances in the health sciences. Also in the private sector, the IBM Co. has funded a program on Technology and Society at Harvard University, which has produced a research review of the literature on the implications of biomedical technology, and the World Council of Churches has recently completed a conference on Technology and the Future of Man and Society.

Finally, Mr. Chairman, a contribution to the public discussion of these questions has also been made by the Joseph P. Kennedy, Jr., Foundation at its

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recent symposium on Human Rights, Research, and Retardation, and by its

funding of an institute at Georgetown University to consider the ethical and moral aspects of medical research.

This brings us to the critical decision points with respect to the proposed legislation. In the light of relevant activities already under

way, and the number of existing institutions concerned on a continuing basis with issues raised by health research advances, is there a need for the National Commission proposed in S.J. Res. 75? The issues are so complex and the underlying currents of change moving so swiftly that in our view no attempt to describe this particular healthscape, at what would have to be a given moment of time, could be definitive for long. In other words, society might be better served by lower-keyed but continuing efforts by the present variety of private and semi-public organizations and entities attempting to assess, rationalize, and

explain.

One cannot help but be impressed by the variety and quality of work already underway in this area, and the seriousness with which individuals and institutions are attempting to deal with these Additional Federal support--apart from that already afforded through various means by such agencies as the National Institutes of Health and the National Science Foundation--does not

matters.

appear to be an urgent need. I am persuaded, too, of the

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appropriateness of a minimum overt role for the Federal Government in the debates and discussions taking place on these very fundamental

issues. For these reasons, I cannot recommend enactment of S.J. Res.

75.

Thank you, Mr. Chairman. I will be happy to answer any further questions you may have.

Senator KENNEDY. Our next witness is Dr. Henry Beecher, Professor Emeritus at Harvard Medical School. He originated the Human Studies Group at Massachusetts General Hospital. He is chairman of the Standing Committee on Ethics at Harvard Medical School, and of a committee to redefine death. He is the author of eight books and 260 articles. His pioneering article in 1966-"Research and the Clinical Investigator" opened up the whole issue of ethics in human experimentation.

STATEMENT OF HENRY K. BEECHER, M.D., HARVARD MEDICAL SCHOOL, CAMBRIDGE, MASS.

Senator KENNEDY. In your paper you outlined 50 examples of outrageous acts. Perhaps you will give us the current status on outrageous acts in your testimony today.

Dr. BEECHER. Thank you. I would like to say something that goes back to what you were saying earlier about dialysis.

I think there is a need for someone to point out the fact that if we had dialysis for all those needing it it wouldn't be any more costly than the care of tuberculosis was in earlier years.

The costs of caring for tuberculosis were greater in earlier years than the costs would be for dialysis for everyone now needing it. Certainly the cost for mental disease is far greater than the cost of dialysis would ever be.

I mention these things simply because it seems to me this brings out a strong argument for the Commission: There is a need for pointing out things of this kind, and the proposed Commission could serve a useful purpose in this area.

Now, to turn to my prepared remarks, we will have progress in medicine. There is no question about that. We must recognize that progress in medicine requires experimentation, and that eventually definitive experimentation must be made in man.

Man is, so to speak, the animal of necessity when it comes to the final validation of a new procedure or agent.

I must of course, stick to my own area of competence. Hopefully, it is in the field of the ethics of human experimentation. The enormous increase in the responsibilities in this area can be illustrated by the following:

SOME DISCRETE ETHICAL PROBLEMS OF MEDICAL RESEARCH

The university hospitals of the land have long been recognized as fields where already discovered concepts are applied, but now it is evident that they are the only places where certain discoveries basic to the advancement of pure science are likely to occur. Such institutions are indispensable units in the advancement of some aspects of conceptual science. In short, a new role of the great teaching hospital is emerging: the advancement of conceptual science through studies of sick man.

This awareness leads to a further extension of human experimentation having seen what fundamental ends can be achieved by experimentation in man, the investigator is led to carry on where nature leaves off. These purposes thus become deeper and more complex than

ever before and so also do the ethical problems surrounding them. What I have to say about experimentation in man has relevance to both basic and applied science.

For some years now a host of important issues have been stated, challenged, argued, debated, fought over, agreed upon, defended, until I sometimes believe I am caught up in a Kafka nightmare. There seems to be endless reiteration of the truth, but nothing new. I am not denigrating the importance of these overworked subjects. The ethical overkill has been tremendous.

I refer to these constantly examined and debated subjects:
Justification for the human trial.

Valid consent. (A goal toward which we must strive but rarely attain in any complete sense).

The engineering of consent.

The perils of using captive groups as subjects, whether ward patients, children, students, prisoners, the dying.

The sterling qualifications required of an investigator.

The doctor-patient relationship versus the doctor-subject relationship.

The ethical problems arising in the transplantation of tissues and organs.

The definition of death-and so on and on and on.

These are, to be sure, important problems and nearly everybody has had his say about them-to the extent that it is unlikely that anything fresh can soon be said. I believe there is another group of less obvious, relatively little discussed, but equally important problems relevant to experimentation in man, and I would like to take a look at them. These inadequately faced areas are inseparable from the tight little microcosm of the investigator and his subject. What are they?

Self-experimentation (when the investigator is also his subject). There was the case of John Hunter, who inoculated himself in 1767 (Treaty on Venereal Disease, 1786) with gonorrheal pus to prove that the disease was thus transmissible. He succeeded, but from the same inoculum he also acquired syphilis and concluded that gonorrhea and syphilis were merely manifestations of the same disease.

THE INVASION OF PRIVACY

But now to come to some of the subtleties that impinge on the microcosm of the investigator and his subject, let us take a look at the invasion of privacy.

As ancient as the common law is, is the principle that the individual shall be protected in his person and in his property. Starting from this, Warren and Brandeis, 80 years ago, recognized that "Political, social, and economic changes entail the recognition of new rights, and the common law, in its eternal youth, grows to meet the demands of society. Later there came a recognition of man's spiritual nature, of his feelings, and his intellect. Gradually the scope of these legal rights broadened; and now the right to life has come to mean the right to enjoy life the right to be let alone." Thus, nearly 80 years ago, there was recognition by legal scholars of the value of sensations, "feelings," enjoyment, recognition that a man had a right to his privacy, privacy so often and so casually threatened in experimentation.