2.4 ANALYSIS OF THE REQUEST
2.4.5 Topoi of Persuasive Attack
Finally, I turn to the argumentative topoi of persuasive attack developed by Benoit and Dorries to consider how the Legacy Committee employed rhetorical tactics to present its case to President
97 Interestingly, though, the Legacy Committee Request—also called the Final Report of the Tuskegee Syphilis Study Legacy Committee—is not addressed directly to the president and employs third-person grammar as typical of a formal report.
98 Legacy Committee, “Legacy Committee Request,” 562-563.
Clinton. Benoit and Dorries focus on two primary concerns of the attacker: increasing the agent’s perceived responsibility for the alleged act and increasing the perceived offensiveness of the alleged act.99 Three of the topoi emphasizing the agent’s responsibility are used within the Legacy Committee request, though not always for the same agent of responsibility. One tactic is to show that the accused has committed the act before. In this case, the Legacy Committee uses this strategy with a twist—not to castigate Clinton for particular wrongdoing, but to call to mind the precedent for official apologies for governmental wrongdoing that he had already established by apologizing for the human radiation experiments during the Cold War.100 Since he had apologized in the past for other administrations’ wrongdoing he should apologize now, the argument goes.
Another tactic is to demonstrate that the accused agent planned the act. The Committee’s request clearly recounts the U.S. Public Health Service’s role in designing and initiating the Tuskegee Syphilis Study in 1932 and persisting in preventing the men in the Study from receiving effective treatment by penicillin when it became available several years later.101 The Legacy Committee’s accusation also emphasizes that the government scientists engaged in
“deliberately deceiving” the men they recruited into the Study.102 This topos specifically points to the Study characteristics that were purposefully and unethically established by the Public Health Service.
Additionally, the request alleges implicitly that the government knew the likely consequences of their actions, another of the attack topoi for agent responsibility. The
99 Benoit and Dorries, “Persuasive Attack,” 464-465.
100 Legacy Committee, “Legacy Committee Request,” 560.
101 Ibid., 559-560.
102 Ibid., 560.
Committee acknowledged that “state of the art” treatments for syphilis were hardly effective in 1932, but criticized the Study investigators for withholding penicillin after it was found to be effective as the standard treatment for syphilis.103 Implicitly, the Legacy Committee alleged that, in withholding treatment from the men for four decades, the government scientists knew they were harming the health of the men in the Study even if that was not necessarily the case at the Study’s inception. While the Study was intended to be an investigation of “untreated syphilis in the male Negro,”104 there was enough scientific knowledge in 1932 to indicate that withholding treatment—even less effective treatments—would be detrimental to the men’s health.
Benoit and Dorries recommend that the persuasive accuser indicate how the accused has benefited from the alleged act. In the case of the Tuskegee Syphilis Study, the investigators must have thought they were gathering important data to expand medical and public health knowledge, but the Legacy Committee cited “lax study protocol” that invalidated the results by enrolling participants who did not meet the study criteria (e.g., some men may have had active rather than latent syphilis).105 In any case, the Legacy Committee did not use this topic of the perpetrator’s gain in its criticism of the U.S. government but relied, instead, on descriptions of the harm done to the victims.
After increasing the agent’s perceived responsibility for wrongdoing according to the tactics outlined above, Benoit and Dorries indicate that an accuser may try to increase the perceived offensiveness of the alleged act. While there are six suggested lines, all of which are eligible for use in an accusation of the government’s role in the Tuskegee Study, the Legacy
103 Ibid.
104 See, for example, a research talk given by one of the Study’s original investigators: O. C. Wenger,
“Untreated Syphilis in Negro Male,” Hot Springs Seminar, September 18, 1950, in Reverby, Tuskegee’s Truths, 96-99.
105 Legacy Committee, “Legacy Committee Request,” 560.
Committee focused on four in particular. First, the Committee recounted the extent of the damage of the Study, explicitly listing the moral harms (deception, being prevented from obtaining standard medical care, “exploitation in research”106), physical harms (fatalities from syphilis are estimated between 28-100 men, spread of active syphilis to family members107), psychological harms (increased distrust and suspicion of the medical profession, fear of exploitation, avoidance of medical treatment108), and harm to the reputation of Tuskegee Institute—now Tuskegee University—because of the name by which the Public Health Service study is remembered.109 This strategy was combined in the request with another strategy:
showing the persistence of the negative effects. For the Legacy Committee, the harm of the Tuskegee Study was not simply in the health consequences for the men in the Study, but in the enduring physical and, particularly, psychological and sociological harms to the broader African American community, many of whom believe that “the fact that the Tuskegee Study occurred at all proves that black life is not valued” in the United States.110 The Committee wrote, “The Tuskegee Syphilis Study continues to cast its long shadow on the contemporary relationship between African Americans and the biomedical community,”111 and repeatedly cited this
“harmful legacy of the Study”112 as a persistent need for official words and actions to “begin the process of regaining the trust of people of color.”113 The harms of the Tuskegee legacy are cited by the Legacy Committee as salient in the present—the Committee used the present tense to
106 Ibid., 560-1.
107 Ibid., 560.
108 Ibid., 561.
109 Ibid.
110 Ibid.
111 Ibid., 559.
112 Ibid., 561.
113 Ibid.
describe the consequences of African Americans’ distrust in government and the medical establishment as well as how “the notoriety of the Study obscures the achievements of the Tuskegee Institute in improving the health care of African Americans.”114 The Committee’s recommendation for a presidential apology and development of grants and programs to enhance bioethics and minority health training were explicitly made in the hopes that such moves would help the country “move beyond Tuskegee and to address the effects of its legacy.”115 The Committee also hoped that a dedicated research and memorial center at Tuskegee “could help transform the legacy of Tuskegee into a positive symbol for all Americans by demonstrating the importance of acknowledging past wrongs, rebuilding trust, and practicing ethical research.”116
The Legacy Committee also attempted to increase the perceived offensiveness of the Tuskegee Study by showing the victims to be innocent and helpless. The Committee described the men in the Tuskegee Study as “poor black sharecroppers from Macon County”117 and
“socially and economically vulnerable African-American men.”118 Later, some of the men were called “elderly survivors”119 and the Study was described as “government abuse of vulnerable people.”120 The report also cited the men’s families, children, unborn children, and “all people of color whose lives reverberate with the consequences of the Study” as victims of the Study, victims who cannot be seen as blameworthy for their hardship, grief, or fear. The Legacy Committee did not explicitly identify the government researchers and doctors as “white,” but the frequent reference to African American victims, “racial wounds,” and the “racial divide” signal
114 Ibid.
115 Ibid., 562.
116 Ibid.
117 Ibid., 559.
118 Ibid., 560.
119 Ibid., 562.
120 Ibid., 559.
that the Tuskegee Study was, among other things, a race issue where the powerful majority abused and exploited the less powerful minority.
The remaining strategies available to the Legacy Committee to emphasize the offensiveness of the Tuskegee Study would be recognized by the reader though they were not explicitly argued in the report. The inconsistency or hypocrisy of the agents are obvious enough not to need spelling out in the request: the Public Health Service ought to be serving the health needs of the citizens rather than purposely putting them in danger, the U.S. government ought not allow—much less promote—the needless abuse of its citizens, and doctors ought to treat their patients rather than keep them from appropriate care. This attack strategy fits well with another: arguing the special obligation of the agents to protect the victims. The doctor/patient, researcher/participant, and perhaps even government/citizen relationships all obligate the party with more power and control to exercise due care in their treatment of their counterparts. These obligations rise above a mere social contract or professional obligation to the level of an ethical obligation.121
The final strategy for increasing the perceived offensiveness of an act, according to Benoit and Dorries, is to show how the act affects the audience. In this case, this strategy is implicitly modified as showing the effects of the Tuskegee Study on those within the jurisdiction of the audience(s)—American citizens and those the CDC aims to reach in their attempts to eliminate racial health disparities. By emphasizing how the legacy of the Tuskegee Study is said
121 An example from the medical field may help to illustrate the connection among professional, legal, and ethical obligations and failures: “If a physician breaches her duty to care and fails to meet the standard of care, we can say that she has acted wrongfully and find her blameworthy according to ethical and professional standards. If that failure of her duty also results in compensable harm to the patient, she would also be liable—by legal standards—for negligence and, thus, malpractice. Ethical culpability and legal culpability do not adhere to all the same criteria, but the standard of care in the medical arena clearly carries implications for both.” Autumn R. Boyer,
“In a ‘Sorry’ State: The Ethics of Institutional Apologies in Response to Medical Errors” (master’s thesis, University of Pittsburgh, 2009), 17-18.
to affect the health care participation of African Americans and breed general distrust of the government, the Legacy Committee appealed to President Clinton’s stated political interests and invoked the mission of another government agency, the CDC, to add additional pressure to President Clinton’s reception of the message. Again, this strategy was not explicitly employed, but the critic would be foolish not to see how the Legacy Committee uses the power of rhetoric to invite its target audience to enact policies consistent with his previously cited priorities.