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Jefferson Parish Public Schools
Table of Contents
Resource
UNIT 1: “What is Rhetoric?”
Author
“What is Rhetoric?”
“Ethos, Pathos, Logos”
“Persuasive Appeals”
Fast Food Nation, ”The Most Dangerous Job”
The Jungle, “Chapter 14”
Common Sense, “Thoughts on the Present State of
American Affairs”
“Address to Congress on Women’s Suffrage”
Silent Spring, “A Fable for Tomorrow”
“Speech to the Second Virginia Convention”
“Does Great Literature Make Us Better?”
“Reading Literature Makes Us Smarter and Nicer”
“Pearl Harbor Address to the Nation”
“Pearl Harbor Address to the Nation” Draft 1
WWII Propaganda Posters
“Henrietta and David Lacks”
Immortal Life of Henrietta Lacks (Prologue)
“Immortal Cells, Moral Issues”
“Immortal Cells, Enduring Issues”
“Cracking the Code of the Human Genome: Henrietta
Lacks’ ‘Immortal’ Cells”
“Everyday Use”
The Sunflower Quilting Bee or Aries
“Women”
Informed Consent
“The Nuremburg Code”
Principles of Medical Ethics
4
Video
--
Gideon O. Burton
Eric Schlosser
Upton Sinclair
Additional Resource
5
6 – 12
13 – 18
Thomas Paine
19 – 30
Carrie Chapman Catt
Rachel Carson
Patrick Henry
Gregory Currie
Annie Murphy Paul
Franklin D. Roosevelt
Franklin D. Roosevelt
The National WWII
Museum
31 – 34
35 – 39
40 – 42
43 – 47
48 – 49
50 – 51
52
UNIT 2: “Henrietta’s Dance”
Author/Source
“Henrietta’s Dance”
Pages
Krista Price
https://www.youtube.com/watch?v=tAsxyffBqm0&noredirect=1
Text Title
Notes
Gideon O. Burton
Additional Resource
53 – 54
Notes
Rebecca Skloot (Johns
Hopkins Magazine)
Smithsonian Magazine
Rebecca Skloot
Ruth R. Faden
Dale Keiger
Sarah Zielinski
Alice Walker
Faith Ringgold
Alice Walker
American Cancer Society
U.S. Department of Health
and Human Services
American Medical
Association
2
Pages
55 – 61
61
62 – 66
67 – 68
69 – 77
78 – 80
Holt
-81
82
83 – 93
94 – 95
96
“What is Rhetoric?”
by Gideon O. Burton
Rhetoric is the study of effective speaking and writing. And the art of persuasion. And
many other things.
In its long and vigorous history rhetoric has enjoyed many definitions, accommodated
differing purposes, and varied widely in what it included. And yet, for most of its
history it has maintained its fundamental character as a discipline for training students
1) to perceive how language is at work orally and in writing, and 2) to become
proficient in applying the resources of language in their own speaking and writing.
(See rhetorical pedagogy)
Discerning how language is working in others' or one's own writing and speaking, one
must (artificially) divide form and content, what is being said and how this is said (see
Content/Form). Because rhetoric examines so attentively the how of language, the
methods and means of communication, it has sometimes been discounted as
something only concerned with style or appearances, and not with the quality or
content of communication. For many (such as Plato) rhetoric deals with the superficial
at best, the deceptive at worst ("mere rhetoric"), when one might better attend to
matters of substance, truth, or reason as attempted in dialectic or philosophy or
religion.
Rhetoric has sometimes lived down to its critics, but as set forth from antiquity,
rhetoric was a comprehensive art just as much concerned with what one could say as
how one might say it. Indeed, a basic premise for rhetoric is the indivisibility of means
from meaning; how one says something conveys meaning as much as what one says.
Rhetoric studies the effectiveness of language comprehensively, including its
emotional impact (see pathos), as much as its propositional content ( see logos). To
see how language and thought worked together, however, it has first been necessary
to artificially divide content and form.
This work is licensed under a Creative Commons Attribution 3.0 License.
Gideon O. Burton, Brigham Young University
Please cite "Silva Rhetoricae" (rhetoric.byu.edu)
3
“Persuasive Appeals”
By Gideon O. Buron
Persuasion, according to Aristotle and the many authorities that
would echo him, is brought about through three kinds of proof
(pistis) or persuasive appeal:
logos
The appeal to reason.
pathos
The appeal to emotion.
ethos
The persuasive appeal of one's
character.
Although they can be analyzed separately, these three appeals work
together in combination toward persuasive ends.
Aristotle calls these "artistic" or "intrinsic" proofs—those that could
be found by means of the art of rhetoric—in contrast to
"nonartistic" or "extrinsic" proofs such as witnesses or contracts
that are simply used by the speaker, not found through rhetoric.
Sources: Arist. Rhet. 1.2.2-3
4
“The Most Dangerous Job” excerpted from the book Fast Food Nation,
By Eric Schlosser, 2002
p. 169
One night I visited a slaughterhouse somewhere in the High Plains. The slaughterhouse is one of
the nation's largest. About five thousand head of cattle enter it every day, single file, and leave
in a different form. Someone who has access to the plant, who's upset by its working
conditions, offers to give me a tour. The slaughterhouse is an immense building, gray and
square, about three stories high, with no windows on the front and no architectural clues to
what's happening inside. My friend gives me a chain-mail apron and gloves, suggesting I try
them on. Workers on the line wear about eight pounds of chain mail beneath their white coats,
shiny steel armor that covers their hands, wrists, stomach, and back. The chain mail's designed
to protect workers from cutting themselves and from being cut by other workers. But knives
somehow manage to get past it. My host hands me some Wellingtons, the kind of knee-high
rubber boots that English gentlemen wear in the countryside. "Tuck your pants into the boots,"
he says. "We'll be walking through some blood."
I put on a hardhat and climb a stairway. The sounds get louder, factory sounds, the noise of
power tools and machinery, bursts of compressed air. We start at the end of the line, the
fabricating room. When we step inside, fab seems familiar: steel catwalks, pipes along the
walls, a vast room, a maze of conveyer belts. Some machines assemble cardboard boxes, others
vacuum-seal subprimals of beef in clear plastic. The workers look extremely busy, but there's
nothing unsettling about this part of the plant. You see meat like this all the time in the back of
your local supermarket.
Workers-about half of them women, almost all of them young and Latino-slice meat with long
slender knives. They stand at a table that's chest high, grab meat off a conveyer belt, trim away
fat, throw meat back on the belt, toss the scraps onto a conveyer belt above them, and then
grab more meat, all in a matter of seconds. I'm now struck by how many workers there are,
hundreds of them, pressed close together, constantly moving, slicing. You see hardhats, white
coats, flashes of steel. Nobody is smiling or chatting, they're too busy, anxiously trying not to
fall behind. An old man walks past me, pushing a blue plastic barrel filled with scraps.
Sides of beef suspended from an overhead trolley swing toward a group of men. Each worker
has a large knife in one hand and a steel hook in the other. They grab the meat with their hooks
and attack it fiercely with their knives.
On the kill floor…it's one strange image after another. A worker with a power saw slices cattle
into halves as though they were two-by-fours, and then the halves swing by me into the cooler.
5
It feels like a slaughterhouse now. Dozens of cattle, stripped of their skins, dangle on chains
from their hind legs. My host stops and asks how I feel, if I want to go any further. This is where
some people get sick. I feel fine, determined to see the whole process, the world that's been
deliberately hidden. The kill floor is hot and humid. It stinks of manure. Cattle have a body
temperature of about 101 degrees, and there are a lot of them in the room. Carcasses swing so
fast along the rail that you have to keep an eye on them constantly, dodge them, watch your
step, or one will slam you and throw you onto the bloody concrete floor. It happens to workers
all the time.
I see: a man reach inside cattle and pull out their kidneys with his bare hands, then drop the
kidneys down a metal chute, over and over again, as each animal passes by him; a stainless
steel rack of tongues; Whizzards peeling meat off decapitated heads, picking them almost as
clean as the white skulls painted by Georgia O'Keeffe. We wade through blood that's ankle
deep and that pours down drains into huge vats below us. As we approach the start of the line,
for the first time I hear the steady pop, pop, pop of live animals being stunned.
For eight and a half hours, a worker called a "sticker" does nothing but stand in a river of blood,
being drenched in blood, slitting the neck of a steer every ten seconds or so, severing its carotid
artery. He uses a long knife and must hit exactly the right spot to kill the animal humanely. He
hits that spot again and again. We walk up a slippery metal stairway and reach a small platform,
where the production line begins. A man turns and smiles at me. He wears safety goggles and a
hardhat. His face is splattered with gray matter and blood. He is the "knocker," the man who
welcomes cattle to the building. Cattle walk down a narrow chute and pause in front of him,
blocked by a gate, and then he shoots them in the head with a captive bolt stunner-a
compressed-air gun attached to the ceiling by a long hose-which fires a steel bolt that knocks
the cattle unconscious. The animals keep strolling up, oblivious to what comes next, and he
stands over them and shoots. For eight and a half hours, he just shoots. As I stand there, he
misses a few times and shoots the same animal twice. As soon as the steer falls, a worker grabs
one of its hind legs, shackles it to a chain, and the chain lifts the huge animal into the air.
p. 172
Meatpacking is now the most dangerous job in the United States. The injury rate in a
slaughterhouse is about three times higher than the rate in a typical American factory. Every
year more than one-quarter of the meatpacking workers in this country-roughly forty thousand
men and women -suffer an injury or a work-related illness that requires medical attention
beyond first aid. Thousands of additional injuries and illnesses most likely go unrecorded.
Despite the use of conveyer belts, forklifts, dehiding machines, and a variety of power tools,
most of the work in the nation's slaughterhouses is still performed by hand. Poultry plants can
6
be largely mechanized, thanks to the breeding of chickens that are uniform in size. But cattle
still come in all sizes and shapes, varying in weight by hundreds of pounds. The lack of a
standardized steer has hindered the mechanization of beef plants. In one crucial respect
meatpacking work has changed little in the past hundred years. At the dawn of the twenty-first
century, amid an era of extraordinary technological advance, the most important tool in a
modern slaughterhouse is a sharp knife.
Lacerations are the most common injuries suffered by meatpackers, who often stab themselves
or stab someone working nearby. Tendinitis and cumulative trauma disorders are also quite
common. Meatpacking workers routinely develop back problems, shoulder problems, carpal
tunnel syndrome, and "trigger finger" (a syndrome in which a finger becomes frozen in a curled
position); Indeed, the rate of these cumulative trauma injuries in the meatpacking industry is
far higher than the rate in any other American industry. It is roughly thirty-three times higher
than the national average in industry. Many slaughterhouse workers make a knife cut every two
or three seconds, which adds up to about 10,000 cuts during an eight-hour shift. If the knife has
become dull, additional pressure is placed on the worker's tendons, joints, and nerves. A dull
knife can cause pain to extend from the cutting hand all the way down the spine.
One of the leading determinants of the injury rate at a slaughterhouse today is the speed of the
disassembly line. The faster it runs, the more likely that workers will get hurt. The old
meatpacking plants in Chicago slaughtered about 50 cattle an hour. Twenty years ago, new
plants in the High Plains slaughtered about 175 cattle an hour. Today some plants slaughter up
to 400 cattle an hour-about half a dozen animals every minute, sent down a single production
line, carved by workers desperate not to fall behind. As the pace increases, so does the risk of
accidental cuts and stabbings…everyone on the line tries to stay alert. Meatpackers often work
within inches of each other, wielding large knives.
p. 176
Some of the most dangerous jobs in meatpacking today are performed by the late-night
cleaning crews. A large proportion of these workers are illegal immigrants. They earn hourly
wages that are about one-third lower than those of regular production employees. And their
work is so hard and so horrendous that words seem inadequate to describe it. The men and
women who now clean the nation's slaughterhouses may arguably have the worst job in the
United States.
When a sanitation crew arrives at a meatpacking plant, usually around midnight, it faces a mess
of monumental proportions. Three to four thousand cattle, each weighing about a thousand
pounds, have been slaughtered there that day. The place has to be clean by sunrise. Some of
the workers wear water-resistant clothing; most don't. Their principal cleaning tool is a high7
pressure hose that shoots a mixture of water and chlorine heated to about 180 degrees. As the
water is sprayed, the plant fills with a thick, heavy fog. Visibility drops to as little as five feet.
The conveyer belts and machinery are running. Workers stand on the belts, spraying them,
riding them like moving sidewalks, as high as fifteen feet off the ground. Workers climb ladders
with hoses and spray the catwalks. They get under tables and conveyer belts, climbing right into
the bloody muck, cleaning out grease, fat, manure, leftover scraps of meat.
Glasses and safety goggles fog up. The inside of the plant heats up; temperatures soon exceed
100 degrees. "It's hot, and it's foggy, and you can't see anything," a former sanitation worker
said. The crew members can't see or hear each other when the machinery's running. They
routinely spray each other with burning hot, chemical-laden water. They are sickened by the
fumes. Jesus, a soft-spoken employee of DCS Sanitation Management, Inc., told me that every
night on the job he gets terrible headaches. "You feel it in your head," he said. "You feel it in
your stomach, like you want to throw up." A friend of his vomits whenever they clean the
rendering area. Jesus says the stench in rendering is so powerful that it won't wash off; no
matter how much soap you use after a shift, the smell comes home with you, seeps from your
pores.
One night while Jesus was cleaning, a coworker forgot to turn off a machine, lost two fingers,
and went into shock. An ambulance came and took him away, as everyone else continued to
dean. He was back at work the following week. "If one hand is no good," the supervisor told
him, "use the other." Another sanitation worker lost an arm in a machine.
Now he folds towels in the locker room. The scariest job, according to Jesus, is cleaning the
vents on the roof of the slaughterhouse. The vents become clogged with grease and dried
blood. In the winter, when everything gets icy and the winds pick up, Jesus worries that a
sudden gust will blow him off the roof into the darkness.
Although official statistics are not kept, the death rate among slaughterhouse sanitation crews
is extraordinarily high. They are the ultimate in disposable workers: illegal, illiterate,
impoverished, untrained. The nation's worst job can end in just about the worst way.
Sometimes these workers are literally ground up and reduced to nothing.
p. 186
During my trips to meatpacking towns in the High Plains I met dozens of workers who'd been
injured. Each of their stories was different, yet somehow familiar, linked by common elementsthe same struggle to receive proper medical care, the same fear of speaking out, the same
underlying corporate indifference. We are human beings, more than one person told me, but
they treat us like animals. Although I cannot tell all of their stories, a few need to be mentioned.
Like all lives, they can be used as examples or serve as representative types. But ultimately they
8
are unique, individual, impossible to define or replace-the opposite of how this system has
treated them.
Raoul was born in Zapoteca, Mexico, and did construction work in Anaheim before moving to
Colorado. He speaks no English. After hearing a Monfort ad on a Spanish-language radio
station, he applied for a job at the Greeley plant. One day Raoul reached into a processing
machine to remove a piece of meat. The machine accidentally went on. Raoul's arm got stuck,
and it took workers twenty minutes to get it out. The machine had to be taken apart. An
ambulance brought Raoul to the hospital, where a deep gash in his shoulder was sewn shut. A
tendon had been severed. After getting stitches and a strong prescription painkiller, he was
driven back to the slaughterhouse and put back on the production line. Bandaged, groggy, and
in pain, one arm tied in a sling, Raoul spent the rest of the day wiping blood off cardboard
boxes with his good hand.
As part of the job in rendering, Kenny Dobbins sometimes had to climb into gigantic blood tanks
and gut bins, reach to the bottom of them with his long arms, and unclog the drains. One day
he was unexpectedly called to work over the weekend. There had been a problem with
Salmonella contamination. The plant needed to be disinfected, and some of the maintenance
workers had refused to do it. In his street clothes, Kenny began cleaning the place, climbing into
tanks and spraying a liquid chlorine mix. Chlorine is a hazardous chemical that can be inhaled or
absorbed through the skin, causing a litany of health problems. Workers who spray it need to
wear protective gloves, safety goggles, a self- contained respirator, and full coveralls. Kenny's
supervisor gave him a paper dust mask to wear, but it quickly dissolved. After eight hours of
working with the chlorine in unventilated areas, Kenny went home and fell ill. He was rushed to
the hospital and placed in an oxygen tent. His lungs had been burned by the chemicals. His
body was covered in blisters. Kenny spent a month in the hospital.
Kenny eventually recovered from the overexposure to chlorine, but it left his chest feeling raw,
made him susceptible to colds and sensitive to chemical aromas. He went back to work at the
Greeley plant. He had remarried, didn't know what other kind of work to do, still felt loyal to
the company. He was assigned to an early morning shift. He had to drive an old truck from one
part of the slaughterhouse complex to another. The truck was filled with leftover scraps of
meat. The headlights and the wipers didn't work. The windshield was filthy and cracked. One
cold, dark morning in the middle of winter, Kenny became disoriented while driving. He
stopped the truck, opened the door, got out to see where he was-and was struck by a train. It
knocked his glasses off, threw him up in the air, and knocked both of his work boots off. The
train was moving slowly, or he would've been killed. Kenny somehow made it back to the plant,
barefoot and bleeding from deep gashes in his back and his face. He spent two weeks at the
hospital, then went back to work.
9
One day, Kenny was in rendering and saw a worker about to stick his head into a pre-breaker
machine, a device that uses hundreds of small hammers to pulverize gristle and bone into a fine
powder. The worker had just turned the machine off, but Kenny knew the hammers inside were
still spinning. It takes fifteen minutes for the machine to shut down completely. Kenny yelled,
"Stop!" but the worker didn't hear him. And so Kenny ran across the room, grabbed the man by
the seat of his pants, and pulled him away from the machine an instant before it would have
pulverized him. To honor this act of bravery, Monfort gave Kenny an award for "Outstanding
Achievement in CONCERN FOR FELLOW WORKERS. The award was a paper certificate, signed by
his supervisor and the plant safety manager.
Kenny later broke his leg stepping into a hole in the slaughterhouse's concrete floor. On
another occasion he shattered an ankle, an injury that required surgery and the insertion of five
steel pins. Now Kenny had to wear a metal brace on one leg in order to walk, an elaborate,
spring-loaded brace that cost $2,000. Standing for long periods caused him great pain. He was
given a job recycling old knives at the plant. Despite his many injuries, the job required him to
climb up and down three flights of narrow stairs carrying garbage bags filled with knives. In
December of 1995 Kenny felt a sharp pain in his chest while lifting some boxes. He thought it
was a heart attack. His union steward took him to see the nurse, who said it was just a pulled
muscle and sent Kenny home. He was indeed having a massive heart attack. A friend rushed
Kenny to a nearby hospital. A stent was inserted in his heart, and the doctors told Kenny that he
was lucky to be alive.
While Kenny Dobbins was recuperating, Monfort fired him. Despite the fact that Kenny had
been with the company for almost sixteen years, despite the fact that he was first in seniority at
the Greeley plant, that he'd cleaned blood tanks with his bare hands, fought the union, done
whatever the company had asked him to do, suffered injuries that would've killed weaker men,
nobody from Monfort called him with the news. Nobody even bothered to write him. Kenny
learned that he'd been fired when his payments to the company health insurance plan kept
being returned by the post office. He called Monfort repeatedly to find out what was going on,
and a sympathetic clerk in the claims office finally told Kenny that the checks were being
returned because he was no longer a Monfort employee. When I asked company spokesmen to
comment on the accuracy of Kenny's story, they would neither confirm nor deny any of the
details. Today Kenny is in poor health. His heart is permanently damaged. His immune system
seems shot. His back hurts, his ankle hurts, and every so often he coughs up blood. He is unable
to work at any job.
His anger at Monfort, his feelings of betrayal, are of truly biblical proportions.
"They used me to the point where I had no body parts left to give," Kenny said, struggling to
maintain his composure. "Then they just tossed me into the trash can." Once strong and
10
powerfully built, he now walks with difficulty, tires easily, and feels useless, as though his life
were over. He is forty-six years old.
http://www.lsrhs.net/departments/history/ShenM/Site/Trials_classwork,_handouts_files/The
%20Most%20Dangerous%20Job%20%28shortened%29-%20Fast%20Food%20Nation.pdf
11
The Jungle, “Chapter 14”
By Upton Sinclair, 1906
With one member trimming beef in a cannery, and another working in a sausage factory, the
family had a first-hand knowledge of the great majority of Packingtown swindles. For it was the
custom, as they found, whenever meat was so spoiled that it could not be used for anything
else, either to can it or else to chop it up into sausage. With what had been told them by Jonas,
who had worked in the pickle rooms, they could now study the whole of the spoiled-meat
industry on the inside, and read a new and grim meaning into that old Packingtown jest—that
they use everything of the pig except the squeal.
Jonas had told them how the meat that was taken out of pickle would often be found sour, and
how they would rub it up with soda to take away the smell, and sell it to be eaten on free-lunch
counters; also of all the miracles of chemistry which they performed, giving to any sort of meat,
fresh or salted, whole or chopped, any color and any flavor and any odor they chose. In the
pickling of hams they had an ingenious apparatus, by which they saved time and increased the
capacity of the plant—a machine consisting of a hollow needle attached to a pump; by plunging
this needle into the meat and working with his foot, a man could fill a ham with pickle in a few
seconds. And yet, in spite of this, there would be hams found spoiled, some of them with an
odor so bad that a man could hardly bear to be in the room with them. To pump into these the
packers had a second and much stronger pickle which destroyed the odor—a process known to
the workers as “giving them thirty per cent.” Also, after the hams had been smoked, there
would be found some that had gone to the bad. Formerly these had been sold as “Number
Three Grade,” but later on some ingenious person had hit upon a new device, and now they
would extract the bone, about which the bad part generally lay, and insert in the hole a whitehot iron. After this invention there was no longer Number One, Two, and Three Grade—there
was only Number One Grade. The packers were always originating such schemes—they had
what they called “boneless hams,” which were all the odds and ends of pork stuffed into
casings; and “California hams,” which were the shoulders, with big knuckle joints, and nearly all
the meat cut out; and fancy “skinned hams,” which were made of the oldest hogs, whose skins
were so heavy and coarse that no one would buy them—that is, until they had been cooked
and chopped fine and labeled “head cheese!”
It was only when the whole ham was spoiled that it came into the department of Elzbieta. Cut
up by the two-thousand-revolutions-a-minute flyers, and mixed with half a ton of other meat,
no odor that ever was in a ham could make any difference. There was never the least attention
paid to what was cut up for sausage; there would come all the way back from Europe old
sausage that had been rejected, and that was moldy and white—it would be dosed with borax
and glycerine, and dumped into the hoppers, and made over again for home consumption.
12
There would be meat that had tumbled out on the floor, in the dirt and sawdust, where the
workers had tramped and spit uncounted billions of consumption germs. There would be meat
stored in great piles in rooms; and the water from leaky roofs would drip over it, and thousands
of rats would race about on it. It was too dark in these storage places to see well, but a man
could run his hand over these piles of meat and sweep off handfuls of the dried dung of rats.
These rats were nuisances, and the packers would put poisoned bread out for them; they
would die, and then rats, bread, and meat would go into the hoppers together. This is no fairy
story and no joke; the meat would be shoveled into carts, and the man who did the shoveling
would not trouble to lift out a rat even when he saw one—there were things that went into the
sausage in comparison with which a poisoned rat was a tidbit. There was no place for the men
to wash their hands before they ate their dinner, and so they made a practice of washing them
in the water that was to be ladled into the sausage. There were the butt-ends of smoked meat,
and the scraps of corned beef, and all the odds and ends of the waste of the plants, that would
be dumped into old barrels in the cellar and left there. Under the system of rigid economy
which the packers enforced, there were some jobs that it only paid to do once in a long time,
and among these was the cleaning out of the waste barrels. Every spring they did it; and in the
barrels would be dirt and rust and old nails and stale water—and cartload after cartload of it
would be taken up and dumped into the hoppers with fresh meat, and sent out to the public’s
breakfast. Some of it they would make into “smoked” sausage—but as the smoking took time,
and was therefore expensive, they would call upon their chemistry department, and preserve it
with borax and color it with gelatine to make it brown. All of their sausage came out of the
same bowl, but when they came to wrap it they would stamp some of it “special,” and for this
they would charge two cents more a pound.
Such were the new surroundings in which Elzbieta was placed, and such was the work she was
compelled to do. It was stupefying, brutalizing work; it left her no time to think, no strength for
anything. She was part of the machine she tended, and every faculty that was not needed for
the machine was doomed to be crushed out of existence. There was only one mercy about the
cruel grind—that it gave her the gift of insensibility. Little by little she sank into a torpor—she
fell silent. She would meet Jurgis and Ona in the evening, and the three would walk home
together, often without saying a word. Ona, too, was falling into a habit of silence—Ona, who
had once gone about singing like a bird. She was sick and miserable, and often she would barely
have strength enough to drag herself home. And there they would eat what they had to eat,
and afterward, because there was only their misery to talk of, they would crawl into bed and
fall into a stupor and never stir until it was time to get up again, and dress by candlelight, and
go back to the machines. They were so numbed that they did not even suffer much from
hunger, now; only the children continued to fret when the food ran short.
13
Yet the soul of Ona was not dead—the souls of none of them were dead, but only sleeping; and
now and then they would waken, and these were cruel times. The gates of memory would roll
open—old joys would stretch out their arms to them, old hopes and dreams would call to them,
and they would stir beneath the burden that lay upon them, and feel its forever immeasurable
weight. They could not even cry out beneath it; but anguish would seize them, more dreadful
than the agony of death. It was a thing scarcely to be spoken—a thing never spoken by all the
world, that will not know its own defeat.
They were beaten; they had lost the game, they were swept aside. It was not less tragic
because it was so sordid, because it had to do with wages and grocery bills and rents. They had
dreamed of freedom; of a chance to look about them and learn something; to be decent and
clean, to see their child grow up to be strong. And now it was all gone—it would never be! They
had played the game and they had lost. Six years more of toil they had to face before they
could expect the least respite, the cessation of the payments upon the house; and how cruelly
certain it was that they could never stand six years of such a life as they were living! They were
lost, they were going down—and there was no deliverance for them, no hope; for all the help it
gave them the vast city in which they lived might have been an ocean waste, a wilderness, a
desert, a tomb. So often this mood would come to Ona, in the nighttime, when something
wakened her; she would lie, afraid of the beating of her own heart, fronting the blood-red eyes
of the old primeval terror of life. Once she cried aloud, and woke Jurgis, who was tired and
cross. After that she learned to weep silently—their moods so seldom came together now! It
was as if their hopes were buried in separate graves.
Jurgis, being a man, had troubles of his own. There was another specter following him. He had
never spoken of it, nor would he allow any one else to speak of it—he had never acknowledged
its existence to himself. Yet the battle with it took all the manhood that he had—and once or
twice, alas, a little more. Jurgis had discovered drink.
He was working in the steaming pit of hell; day after day, week after week—until now, there
was not an organ of his body that did its work without pain, until the sound of ocean breakers
echoed in his head day and night, and the buildings swayed and danced before him as he went
down the street. And from all the unending horror of this there was a respite, a deliverance—
he could drink! He could forget the pain, he could slip off the burden; he would see clearly
again, he would be master of his brain, of his thoughts, of his will. His dead self would stir in
him, and he would find himself laughing and cracking jokes with his companions—he would be
a man again, and master of his life.
It was not an easy thing for Jurgis to take more than two or three drinks. With the first drink he
could eat a meal, and he could persuade himself that that was economy; with the second he
could eat another meal—but there would come a time when he could eat no more, and then to
14
pay for a drink was an unthinkable extravagance, a defiance of the agelong instincts of his
hunger-haunted class. One day, however, he took the plunge, and drank up all that he had in
his pockets, and went home half “piped,” as the men phrase it. He was happier than he had
been in a year; and yet, because he knew that the happiness would not last, he was savage, too
with those who would wreck it, and with the world, and with his life; and then again, beneath
this, he was sick with the shame of himself. Afterward, when he saw the despair of his family,
and reckoned up the money he had spent, the tears came into his eyes, and he began the long
battle with the specter.
It was a battle that had no end, that never could have one. But Jurgis did not realize that very
clearly; he was not given much time for reflection. He simply knew that he was always fighting.
Steeped in misery and despair as he was, merely to walk down the street was to be put upon
the rack. There was surely a saloon on the corner—perhaps on all four corners, and some in the
middle of the block as well; and each one stretched out a hand to him each one had a
personality of its own, allurements unlike any other. Going and coming—before sunrise and
after dark—there was warmth and a glow of light, and the steam of hot food,and perhaps
music, or a friendly face, and a word of good cheer. Jurgis developed a fondness for having Ona
on his arm whenever he went out on the street, and he would hold her tightly, and walk fast. It
was pitiful to have Ona know of this—it drove him wild to think of it; the thing was not fair, for
Ona had never tasted drink, and so could not understand. Sometimes, in despeate hours, he
would find himself wishing that she might learn what it was, so that he need not be ashamed in
her presence. They might drink together, and escape from the horror—escape for a while,
come what would.
So there came a time when nearly all the conscious life of Jurgis consisted of a struggle with the
craving for liquor. He would have ugly moods, when he hated Ona and the whole family,
because they stood in his way. He was a fool to have married; he had tied himself down, had
made himself a slave. It was all because he was a married man that he was compelled to stay in
the yards; if it had not been for that he might have gone off like Jonas, and to hell with the
packers. There were few single men in the fertilizer mill—and those few were working only for
a chance to escape. Meantime, too, they had something to think about while they worked,—
they had the memory of the last time they had been drunk, and the hope of the time when
they would be drunk again. As for Jurgis, he was expected to bring home every penny; he could
not even go with the men at noontime—he was supposed to sit down and eat his dinner on a
pile of fertilizer dust.
This was not always his mood, of course; he still loved his family. But just now was a time of
trial. Poor little Antanas, for instance—who had never failed to win him with a smile—little
Antanas was not smiling just now, being a mass of fiery red pimples. He had had all the diseases
15
that babies are heir to, in quick succession, scarlet fever, mumps, and whooping cough in the
first year, and now he was down with the measles. There was no one to attend him but Kotrina;
there was no doctor to help him, because they were too poor, and children did not die of the
measles—at least not often. Now and then Kotrina would find time to sob over his woes, but
for the greater part of the time he had to be left alone, barricaded upon the bed. The floor was
full of drafts, and if he caught cold he would die. At night he was tied down, lest he should kick
the covers off him, while the family lay in their stupor of exhaustion. He would lie and scream
for hours, almost in convulsions; and then, when he was worn out, he would lie whimpering
and wailing in his torment. He was burning up with fever, and his eyes were running sores; in
the daytime he was a thing uncanny and impish to behold, a plaster of pimples and sweat, a
great purple lump of misery.
Yet all this was not really as cruel as it sounds, for, sick as he was, little Antanas was the least
unfortunate member of that family. He was quite able to bear his sufferings—it was as if he had
all these complaints to show what a prodigy of health he was. He was the child of his parents’
youth and joy; he grew up like the conjurer’s rosebush, and all the world was his oyster. In
general, he toddled around the kitchen all day with a lean and hungry look—the portion of the
family’s allowance that fell to him was not enough, and he was unrestrainable in his demand
for more. Antanas was but little over a year old, and already no one but his father could
manage him.
It seemed as if he had taken all of his mother’s strength—had left nothing for those that might
come after him. Ona was with child again now, and it was a dreadful thing to contemplate;
even Jurgis, dumb and despairing as he was, could not but understand that yet other agonies
were on the way, and shudder at the thought of them.
For Ona was visibly going to pieces. In the first place she was developing a cough, like the one
that had killed old Dede Antanas. She had had a trace of it ever since that fatal morning when
the greedy streetcar corporation had turned her out into the rain; but now it was beginning to
grow serious, and to wake her up at night. Even worse than that was the fearful nervousness
from which she suffered; she would have frightful headaches and fits of aimless weeping; and
sometimes she would come home at night shuddering and moaning, and would fling herself
down upon the bed and burst into tears. Several times she was quite beside herself and
hysterical; and then Jurgis would go half-mad with fright. Elzbieta would explain to him that it
could not be helped, that a woman was subject to such things when she was pregnant; but he
was hardly to be persuaded, and would beg and plead to know what had happened. She had
never been like this before, he would argue—it was monstrous and unthinkable. It was the life
she had to live, the accursed work she had to do, that was killing her by inches. She was not
fitted for it—no woman was fitted for it, no woman ought to be allowed to do such work; if the
16
world could not keep them alive any other way it ought to kill them at once and be done with it.
They ought not to marry, to have children; no workingman ought to marry—if he, Jurgis, had
known what a woman was like, he would have had his eyes torn out first. So he would carry on,
becoming half hysterical himself, which was an unbearable thing to see in a big man; Ona would
pull herself together and fling herself into his arms, begging him to stop, to be still, that she
would be better, it would be all right. So she would lie and sob out her grief upon his shoulder,
while he gazed at her, as helpless as a wounded animal, the target of unseen enemies.
http://etc.usf.edu/lit2go/77/the-jungle/1276/chapter-14/
17
Published in 1776, Common Sense challenged the authority of the British government
and the royal monarchy. The plain language that Paine used spoke to the common
people of America and was the first work to openly ask for independence from Great
Britain.
Introduction to the Third Edition
Perhaps the sentiments contained in the following pages, are not YET sufficiently fashionable to
procure them general favour; a long habit of not thinking a thing WRONG, gives it a superficial
appearance of being RIGHT, and raises at first a formidable outcry in defense of custom. But the
tumult soon subsides. Time makes more converts than reason. As a long and violent abuse of
power, is generally the Means of calling the right of it in question (and in Matters too which
might never have been thought of, had not the Sufferers been aggravated into the inquiry) and
as the King of England hath undertaken in his OWN RIGHT, to support the Parliament in what
he calls THEIRS, and as the good people of this country are grievously oppressed by the
combination, they have an undoubted privilege to inquire into the pretensions of both, and
equally to reject the usurpation of either. In the following sheets, the author hath studiously
avoided every thing which is personal among ourselves. Compliments as well as censure to
individuals make no part thereof. The wise, and the worthy, need not the triumph of a
pamphlet; and those whose sentiments are injudicious, or unfriendly, will cease of themselves
unless too much pains are bestowed upon their conversion. The cause of America is in a great
measure the cause of all mankind. Many circumstances hath, and will arise, which are not local,
but universal, and through which the principles of all Lovers of Mankind are affected, and in the
Event of which, their Affections are interested. The laying a Country desolate with Fire and
Sword, declaring War against the natural rights of all Mankind, and extirpating the Defenders
thereof from the Face of the Earth, is the Concern of every Man to whom Nature hath given the
Power of feeling; of which Class, regardless of Party Censure, is the AUTHOR.
P. S. The Publication of this new Edition hath been delayed, with a View of taking notice (had it
been necessary) of any Attempt to refute the Doctrine of Independence: As no Answer hath yet
appeared, it is now presumed that none will, the Time needful for getting such a Performance
ready for the Public being considerably past. Who the Author of this Production is, is wholly
unnecessary to the Public, as the Object for Attention is the DOCTRINE ITSELF, not the MAN. Yet
it may not be unnecessary to say, That he is unconnected with any Party, and under no sort of
Influence public or private, but the influence of reason and principle.
Philadelphia, February 14, 1776
18
Thoughts on the Present State of American Affairs
IN the following pages I offer nothing more than simple facts, plain arguments, and common
sense: and have no other preliminaries to settle with the reader, than that he will divest himself
of prejudice and prepossession, and suffer his reason and his feelings to determine for
themselves that he will put on, or rather that he will not put off, the true character of a man,
and generously enlarge his views beyond the present day.
Volumes have been written on the subject of the struggle between England and America. Men
of all ranks have embarked in the controversy, from different motives, and with various
designs; but all have been ineffectual, and the period of debate is closed. Arms as the last
resource decide the contest; the appeal was the choice of the King, and the Continent has
accepted the challenge.
It hath been reported of the late Mr. Pelham (who tho' an able minister was not without his
faults) that on his being attacked in the House of Commons on the score that his measures
were only of a temporary kind, replied, "THEY WILL LAST MY TIME." Should a thought so fatal
and unmanly possess the Colonies in the present contest, the name of ancestors will be
remembered by future generations with detestation.
The Sun never shined on a cause of greater worth. 'Tis not the affair of a City, a County, a
Province, or a Kingdom; but of a Continent — of at least one-eighth part of the habitable Globe.
'Tis not the concern of a day, a year, or an age; posterity are virtually involved in the contest,
and will be more or less affected even to the end of time, by the proceedings now. Now is the
seed-time of Continental union, faith and honour. The least fracture now will be like a name
engraved with the point of a pin on the tender rind of a young oak; the wound would enlarge
with the tree, and posterity read in it full grown characters.
By referring the matter from argument to arms, a new era for politics is struck — a new method
of thinking hath arisen. All plans, proposals, &c. prior to the nineteenth of April, i.e. to the
commencement of hostilities, are like the almanacks of the last year; which tho' proper then,
are superseded and useless now. Whatever was advanced by the advocates on either side of
the question then, terminated in one and the same point, viz. a union with Great Britain; the
only difference between the parties was the method of effecting it; the one proposing force,
the other friendship; but it hath so far happened that the first hath failed, and the second hath
withdrawn her influence.
As much hath been said of the advantages of reconciliation, which, like an agreeable dream,
hath passed away and left us as we were, it is but right that we should examine the contrary
side of the argument, and enquire into some of the many material injuries which these Colonies
sustain, and always will sustain, by being connected with and dependent on Great Britain. To
examine that connection and dependence, on the principles of nature and common sense, to
see what we have to trust to, if separated, and what we are to expect, if dependent.
19
I have heard it asserted by some, that as America has flourished under her former connection
with Great Britain, the same connection is necessary towards her future happiness, and will
always have the same effect. Nothing can be more fallacious than this kind of argument. We
may as well assert that because a child has thrived upon milk, that it is never to have meat, or
that the first twenty years of our lives is to become a precedent for the next twenty. But even
this is admitting more than is true; for I answer roundly that America would have flourished as
much, and probably much more, had no European power taken any notice of her. The
commerce by which she hath enriched herself are the necessaries of life, and will always have a
market while eating is the custom of Europe.
But she has protected us, say some. That she hath engrossed us is true, and defended the
Continent at our expense as well as her own, is admitted; and she would have defended Turkey
from the same motive, viz. — for the sake of trade and dominion.
Alas! we have been long led away by ancient prejudices and made large sacrifices to
superstition. We have boasted the protection of Great Britain, without considering, that her
motive was INTEREST not ATTACHMENT; and that she did not protect us from OUR ENEMIES on
OUR ACCOUNT; but from HER ENEMIES on HER OWN ACCOUNT, from those who had no
quarrel with us on any OTHER ACCOUNT, and who will always be our enemies on the SAME
ACCOUNT. Let Britain waive her pretensions to the Continent, or the Continent throw off the
dependence, and we should be at peace with France and Spain, were they at war with Britain.
The miseries of Hanover last war ought to warn us against connections.
It hath lately been asserted in parliament, that the Colonies have no relation to each other but
through the Parent Country, i.e. that Pennsylvania and the Jerseys and so on for the rest, are
sister Colonies by the way of England; this is certainly a very roundabout way of proving
relationship, but it is the nearest and only true way of proving enmity (or enemyship, if I may so
call it.) France and Spain never were, nor perhaps ever will be, our enemies as AMERICANS, but
as our being the SUBJECTS OF GREAT BRITAIN.
But Britain is the parent country, say some. Then the more shame upon her conduct. Even
brutes do not devour their young, nor savages make war upon their families. Wherefore, the
assertion, if true, turns to her reproach; but it happens not to be true, or only partly so, and the
phrase PARENT OR MOTHER COUNTRY hath been jesuitically adopted by the King and his
parasites, with a low papistical design of gaining an unfair bias on the credulous weakness of
our minds. Europe, and not England, is the parent country of America. This new World hath
been the asylum for the persecuted lovers of civil and religious liberty from EVERY PART of
Europe. Hither have they fled, not from the tender embraces of the mother, but from the
cruelty of the monster; and it is so far true of England, that the same tyranny which drove the
first emigrants from home, pursues their descendants still.
In this extensive quarter of the globe, we forget the narrow limits of three hundred and sixty
miles (the extent of England) and carry our friendship on a larger scale; we claim brotherhood
with every European Christian, and triumph in the generosity of the sentiment.
20
It is pleasant to observe by what regular gradations we surmount the force of local prejudices,
as we enlarge our acquaintance with the World. A man born in any town in England divided into
parishes, will naturally associate most with his fellow parishioners (because their interests in
many cases will be common) and distinguish him by the name of NEIGHBOR; if he meet him but
a few miles from home, he drops the narrow idea of a street, and salutes him by the name of
TOWNSMAN; if he travel out of the county and meet him in any other, he forgets the minor
divisions of street and town, and calls him COUNTRYMAN, i.e. COUNTYMAN; but if in their
foreign excursions they should associate in France, or any other part of EUROPE, their local
remembrance would be enlarged into that of ENGLISHMEN. And by a just parity of reasoning,
all Europeans meeting in America, or any other quarter of the globe, are COUNTRYMEN; for
England, Holland, Germany, or Sweden, when compared with the whole, stand in the same
places on the larger scale, which the divisions of street, town, and county do on the smaller
ones; Distinctions too limited for Continental minds. Not one third of the inhabitants, even of
this province, [Pennsylvania], are of English descent. Wherefore, I reprobate the phrase of
Parent or Mother Country applied to England only, as being false, selfish, narrow and
ungenerous.
But, admitting that we were all of English descent, what does it amount to? Nothing. Britain,
being now an open enemy, extinguishes every other name and title: and to say that
reconciliation is our duty, is truly farcical. The first king of England, of the present line (William
the Conqueror) was a Frenchman, and half the peers of England are descendants from the
same country; wherefore, by the same method of reasoning, England ought to be governed by
France.
Much hath been said of the united strength of Britain and the Colonies, that in conjunction they
might bid defiance to the world. But this is mere presumption; the fate of war is uncertain,
neither do the expressions mean anything; for this continent would never suffer itself to be
drained of inhabitants, to support the British arms in either Asia, Africa, or Europe.
Besides, what have we to do with setting the world at defiance? Our plan is commerce, and
that, well attended to, will secure us the peace and friendship of all Europe; because it is the
interest of all Europe to have America a free port. Her trade will always be a protection, and her
barrenness of gold and silver secure her from invaders.
I challenge the warmest advocate for reconciliation to show a single advantage that this
continent can reap by being connected with Great Britain. I repeat the challenge; not a single
advantage is derived. Our corn will fetch its price in any market in Europe, and our imported
goods must be paid for buy them where we will.
But the injuries and disadvantages which we sustain by that connection, are without number;
and our duty to mankind at large, as well as to ourselves, instruct us to renounce the alliance:
because, any submission to, or dependence on, Great Britain, tends directly to involve this
Continent in European wars and quarrels, and set us at variance with nations who would
otherwise seek our friendship, and against whom we have neither anger nor complaint. As
21
Europe is our market for trade, we ought to form no partial connection with any part of it. It is
the true interest of America to steer clear of European contentions, which she never can do,
while, by her dependence on Britain, she is made the makeweight in the scale of British politics.
Europe is too thickly planted with Kingdoms to be long at peace, and whenever a war breaks
out between England and any foreign power, the trade of America goes to ruin, BECAUSE OF
HER CONNECTION WITH BRITAIN. The next war may not turn out like the last, and should it not,
the advocates for reconciliation now will be wishing for separation then, because neutrality in
that case would be a safer convoy than a man of war. Every thing that is right or reasonable
pleads for separation. The blood of the slain, the weeping voice of nature cries, 'TIS TIME TO
PART. Even the distance at which the Almighty hath placed England and America is a strong and
natural proof that the authority of the one over the other, was never the design of Heaven. The
time likewise at which the Continent was discovered, adds weight to the argument, and the
manner in which it was peopled, encreases the force of it. The Reformation was preceded by
the discovery of America: As if the Almighty graciously meant to open a sanctuary to the
persecuted in future years, when home should afford neither friendship nor safety.
The authority of Great Britain over this continent, is a form of government, which sooner or
later must have an end: And a serious mind can draw no true pleasure by looking forward,
under the painful and positive conviction that what he calls "the present constitution" is merely
temporary. As parents, we can have no joy, knowing that this government is not sufficiently
lasting to ensure any thing which we may bequeath to posterity: And by a plain method of
argument, as we are running the next generation into debt, we ought to do the work of it,
otherwise we use them meanly and pitifully. In order to discover the line of our duty rightly, we
should take our children in our hand, and fix our station a few years farther into life; that
eminence will present a prospect which a few present fears and prejudices conceal from our
sight.
Though I would carefully avoid giving unnecessary offence, yet I am inclined to believe, that all
those who espouse the doctrine of reconciliation, may be included within the following
descriptions. Interested men, who are not to be trusted, weak men who CANNOT see,
prejudiced men who will not see, and a certain set of moderate men who think better of the
European world than it deserves; and this last class, by an ill-judged deliberation, will be the
cause of more calamities to this Continent than all the other three.
It is the good fortune of many to live distant from the scene of present sorrow; the evil is not
sufficiently brought to their doors to make them feel the precariousness with which all
American property is possessed. But let our imaginations transport us a few moments to
Boston; that seat of wretchedness will teach us wisdom, and instruct us for ever to renounce a
power in whom we can have no trust. The inhabitants of that unfortunate city who but a few
months ago were in ease and affluence, have now no other alternative than to stay and starve,
or turn out to beg. Endangered by the fire of their friends if they continue within the city and
plundered by the soldiery if they leave it, in their present situation they are prisoners without
22
the hope of redemption, and in a general attack for their relief they would be exposed to the
fury of both armies.
Men of passive tempers look somewhat lightly over the offences of Great Britain, and, still
hoping for the best, are apt to call out, "Come, come, we shall be friends again for all this." But
examine the passions and feelings of mankind: bring the doctrine of reconciliation to the
touchstone of nature, and then tell me whether you can hereafter love, honour, and faithfully
serve the power that hath carried fire and sword into your land? If you cannot do all these, then
are you only deceiving yourselves, and by your delay bringing ruin upon posterity. Your future
connection with Britain, whom you can neither love nor honour, will be forced and unnatural,
and being formed only on the plan of present convenience, will in a little time fall into a relapse
more wretched than the first. But if you say, you can still pass the violations over, then I ask,
hath your house been burnt? Hath your property been destroyed before your face? Are your
wife and children destitute of a bed to lie on, or bread to live on? Have you lost a parent or a
child by their hands, and yourself the ruined and wretched survivor? If you have not, then are
you not a judge of those who have. But if you have, and can still shake hands with the
murderers, then are you unworthy the name of husband, father, friend or lover, and whatever
may be your rank or title in life, you have the heart of a coward, and the spirit of a sycophant.
This is not inflaming or exaggerating matters, but trying them by those feelings and affections
which nature justifies, and without which, we should be incapable of discharging the social
duties of life, or enjoying the felicities of it. I mean not to exhibit horror for the purpose of
provoking revenge, but to awaken us from fatal and unmanly slumbers, that we may pursue
determinately some fixed object. It is not in the power of Britain or of Europe to conquer
America, if she do not conquer herself by delay and timidity. The present winter is worth an age
if rightly employed, but if lost or neglected, the whole continent will partake of the misfortune;
and there is no punishment which that man will not deserve, be he who, or what, or where he
will, that may be the means of sacrificing a season so precious and useful.
It is repugnant to reason, to the universal order of things to all examples from former ages, to
suppose, that this continent can longer remain subject to any external power. The most
sanguine in Britain does not think so. The utmost stretch of human wisdom cannot, at this time,
compass a plan short of separation, which can promise the continent even a year's security.
Reconciliation is now a falacious dream. Nature hath deserted the connexion, and Art cannot
supply her place. For, as Milton wisely expresses, "never can true reconcilement grow where
wounds of deadly hate have pierced so deep."
Every quiet method for peace hath been ineffectual. Our prayers have been rejected with
disdain; and only tended to convince us, that nothing flatters vanity, or confirms obstinacy in
Kings more than repeated petitioning — and nothing hath contributed more than that very
measure to make the Kings of Europe absolute: Witness Denmark and Sweden. Wherefore,
since nothing but blows will do, for God's sake, let us come to a final separation, and not leave
the next generation to be cutting throats, under the violated unmeaning names of parent and
child.
23
To say, they will never attempt it again is idle and visionary, we thought so at the repeal of the
stamp act, yet a year or two undeceived us; as well may we suppose that nations, which have
been once defeated, will never renew the quarrel.
As to government matters, it is not in the power of Britain to do this continent justice: The
business of it will soon be too weighty, and intricate, to be managed with any tolerable degree
of convenience, by a power, so distant from us, and so very ignorant of us; for if they cannot
conquer us, they cannot govern us. To be always running three or four thousand miles with a
tale or a petition, waiting four or five months for an answer, which when obtained requires five
or six more to explain it in, will in a few years be looked upon as folly and childishness — There
was a time when it was proper, and there is a proper time for it to cease.
Small islands not capable of protecting themselves, are the proper objects for kingdoms to take
under their care; but there is something very absurd, in supposing a continent to be perpetually
governed by an island. In no instance hath nature made the satellite larger than its primary
planet, and as England and America, with respect to each other, reverses the common order of
nature, it is evident they belong to different systems: England to Europe, America to itself.
I am not induced by motives of pride, party, or resentment to espouse the doctrine of
separation and independence; I am clearly, positively, and conscientiously persuaded that it is
the true interest of this continent to be so; that every thing short of that is mere patchwork,
that it can afford no lasting felicity, — that it is leaving the sword to our children, and shrinking
back at a time, when, a little more, a little farther, would have rendered this continent the glory
of the earth.
As Britain hath not manifested the least inclination towards a compromise, we may be assured
that no terms can be obtained worthy the acceptance of the continent, or any ways equal to
the expense of blood and treasure we have been already put to.
The object, contended for, ought always to bear some just proportion to the expense. The
removal of North, or the whole detestable junto, is a matter unworthy the millions we have
expended. A temporary stoppage of trade, was an inconvenience, which would have sufficiently
balanced the repeal of all the acts complained of, had such repeals been obtained; but if the
whole continent must take up arms, if every man must be a soldier, it is scarcely worth our
while to fight against a contemptible ministry only. Dearly, dearly, do we pay for the repeal of
the acts, if that is all we fight for; for in a just estimation, it is as great a folly to pay a Bunker-hill
price for law, as for land. As I have always considered the independency of this continent, as an
event, which sooner or later must arrive, so from the late rapid progress of the continent to
maturity, the event could not be far off. Wherefore, on the breaking out of hostilities, it was not
worth the while to have disputed a matter, which time would have finally redressed, unless we
meant to be in earnest; otherwise, it is like wasting an estate on a suit at law, to regulate the
trespasses of a tenant, whose lease is just expiring. No man was a warmer wisher for
reconciliation than myself, before the fatal nineteenth of April 1775, but the moment the event
of that day was made known, I rejected the hardened, sullen tempered Pharaoh of England for
24
ever; and disdain the wretch, that with the pretended title of FATHER OF HIS PEOPLE, can
unfeelingly hear of their slaughter, and composedly sleep with their blood upon his soul.
But admitting that matters were now made up, what would be the event? I answer, the ruin of
the continent. And that for several reasons.
First. The powers of governing still remaining in the hands of the king, he will have a negative
over the whole legislation of this continent. And as he hath shewn himself such an inveterate
enemy to liberty, and discovered such a thirst for arbitrary power; is he, or is he not, a proper
man to say to these colonies, "You shall make no laws but what I please." And is there any
inhabitant in America so ignorant, as not to know, that according to what is called the present
constitution, that this continent can make no laws but what the king gives it leave to; and is
there any man so unwise, as not to see, that (considering what has happened) he will suffer no
law to be made here, but such as suit his purpose. We may be as effectually enslaved by the
want of laws in America, as by submitting to laws made for us in England. After matters are
made up (as it is called) can there be any doubt, but the whole power of the crown will be
exerted, to keep this continent as low and humble as possible? Instead of going forward we
shall go backward, or be perpetually quarrelling or ridiculously petitioning. — We are already
greater than the king wishes us to be, and will he not hereafter endeavour to make us less? To
bring the matter to one point. Is the power who is jealous of our prosperity, a proper power to
govern us? Whoever says No to this question is an independent, for independency means no
more, than, whether we shall make our own laws, or, whether the king, the greatest enemy this
continent hath, or can have, shall tell us, "there shall be no laws but such as I like."
But the king you will say has a negative in England; the people there can make no laws without
his consent. In point of right and good order, there is something very ridiculous, that a youth of
twenty-one (which hath often happened) shall say to several millions of people, older and wiser
than himself, I forbid this or that act of yours to be law. But in this place I decline this sort of
reply, though I will never cease to expose the absurdity of it, and only answer, that England
being the King's residence, and America not so, make quite another case. The king's negative
here is ten times more dangerous and fatal than it can be in England, for there he will scarcely
refuse his consent to a bill for putting England into as strong a state of defence as possible, and
in America he would never suffer such a bill to be passed.
America is only a secondary object in the system of British politics, England consults the good of
this country, no farther than it answers her own purpose. Wherefore, her own interest leads
her to suppress the growth of ours in every case which doth not promote her advantage, or in
the least interferes with it. A pretty state we should soon be in under such a second-hand
government, considering what has happened! Men do not change from enemies to friends by
the alteration of a name: And in order to shew that reconciliation now is a dangerous doctrine, I
affirm, that it would be policy in the king at this time, to repeal the acts for the sake of
reinstating himself in the government of the provinces; in order that HE MAY ACCOMPLISH BY
CRAFT AND SUBTILITY, IN THE LONG RUN, WHAT HE CANNOT DO BY FORCE AND VIOLENCE IN
THE SHORT ONE. Reconciliation and ruin are nearly related.
25
Secondly. That as even the best terms, which we can expect to obtain, can amount to no more
than a temporary expedient, or a kind of government by guardianship, which can last no longer
than till the colonies come of age, so the general face and state of things, in the interim, will be
unsettled and unpromising. Emigrants of property will not choose to come to a country whose
form of government hangs but by a thread, and who is every day tottering on the brink of
commotion and disturbance; and numbers of the present inhabitants would lay hold of the
interval, to dispose of their effects, and quit the continent.
But the most powerful of all arguments, is, that nothing but independence, i. e. a continental
form of government, can keep the peace of the continent and preserve it inviolate from civil
wars. I dread the event of a reconciliation with Britain now, as it is more than probable, that it
will followed by a revolt somewhere or other, the consequences of which may be far more fatal
than all the malice of Britain.
Thousands are already ruined by British barbarity; (thousands more will probably suffer the
same fate.) Those men have other feelings than us who have nothing suffered. All they now
possess is liberty, what they before enjoyed is sacrificed to its service, and having nothing more
to lose, they disdain submission. Besides, the general temper of the colonies, towards a British
government, will be like that of a youth, who is nearly out of his time; they will care very little
about her. And a government which cannot preserve the peace, is no government at all, and in
that case we pay our money for nothing; and pray what is it that Britain can do, whose power
will be wholly on paper, should a civil tumult break out the very day after reconciliation? I have
heard some men say, many of whom I believe spoke without thinking, that they dreaded an
independence, fearing that it would produce civil wars. It is but seldom that our first thoughts
are truly correct, and that is the case here; for there are ten times more to dread from a
patched up connexion than from independence. I make the sufferers case my own, and I
protest, that were I driven from house and home, my property destroyed, and my
circumstances ruined, that as a man, sensible of injuries, I could never relish the doctrine of
reconciliation, or consider myself bound thereby.
The colonies have manifested such a spirit of good order and obedience to continental
government, as is sufficient to make every reasonable person easy and happy on that head. No
man can assign the least pretence for his fears, on any other grounds, that such as are truly
childish and ridiculous, viz. that one colony will be striving for superiority over another.
Where there are no distinctions there can be no superiority, perfect equality affords no
temptation. The republics of Europe are all (and we may say always) in peace. Holland and
Swisserland are without wars, foreign or domestic: Monarchical governments, it is true, are
never long at rest; the crown itself is a temptation to enterprizing ruffians at home; and that
degree of pride and insolence ever attendant on regal authority, swells into a rupture with
foreign powers, in instances, where a republican government, by being formed on more natural
principles, would negotiate the mistake.
26
If there is any true cause of fear respecting independence, it is because no plan is yet laid down.
Men do not see their way out — Wherefore, as an opening into that business, I offer the
following hints; at the same time modestly affirming, that I have no other opinion of them
myself, than that they may be the means of giving rise to something better. Could the straggling
thoughts of individuals be collected, they would frequently form materials for wise and able
men to improve into useful matter.
Let the assemblies be annual, with a President only. The representation more equal. Their
business wholly domestic, and subject to the authority of a Continental Congress.
Let each colony be divided into six, eight, or ten, convenient districts, each district to send a
proper number of delegates to Congress, so that each colony send at least thirty. The whole
number in Congress will be least 390. Each Congress to sit and to choose a president by the
following method. When the delegates are met, let a colony be taken from the whole thirteen
colonies by lot, after which, let the whole Congress choose (by ballot) a president from out of
the delegates of that province. In the next Congress, let a colony be taken by lot from twelve
only, omitting that colony from which the president was taken in the former Congress, and so
proceeding on till the whole thirteen shall have had their proper rotation. And in order that
nothing may pass into a law but what is satisfactorily just, not less than three fifths of the
Congress to be called a majority. — He that will promote discord, under a government so
equally formed as this, would have joined Lucifer in his revolt.
But as there is a peculiar delicacy, from whom, or in what manner, this business must first arise,
and as it seems most agreeable and consistent that it should come from some intermediate
body between the governed and the governors, that is, between the Congress and the people,
let a CONTINENTAL CONFERENCE be held, in the following manner, and for the following
purpose.
A committee of twenty-six members of Congress, viz. two for each colony. Two members for
each House of Assembly, or Provincial Convention; and five representatives of the people at
large, to be chosen in the capital city or town of each province, for, and in behalf of the whole
province, by as many qualified voters as shall think proper to attend from all parts of the
province for that purpose; or, if more convenient, the representatives may be chosen in two or
three of the most populous parts thereof. In this conference, thus assembled, will be united,
the two grand principles of business, knowledge and power. The members of Congress,
Assemblies, or Conventions, by having had experience in national concerns, will be able and
useful counsellors, and the whole, being impowered by the people, will have a truly legal
authority.
The conferring members being met, let their business be to frame a CONTINENTAL CHARTER, or
Charter of the United Colonies; (answering to what is called the Magna Charta of England) fixing
the number and manner of choosing members of Congress, members of Assembly, with their
date of sitting, and drawing the line of business and jurisdiction between them: (Always
remembering, that our strength is continental, not provincial:) Securing freedom and property
27
to all men, and above all things, the free exercise of religion, according to the dictates of
conscience; with such other matter as is necessary for a charter to contain. Immediately after
which, the said Conference to dissolve, and the bodies which shall be chosen comformable to
the said charter, to be the legislators and governors of this continent for the time being: Whose
peace and happiness, may God preserve, Amen.
Should any body of men be hereafter delegated for this or some similar purpose, I offer them
the following extracts from that wise observer on governments Dragonetti. "The science" says
he "of the politician consists in fixing the true point of happiness and freedom. Those men
would deserve the gratitude of ages, who should discover a mode of government that
contained the greatest sum of individual happiness, with the least national expense."
"Dragonetti on virtue and rewards."
But where says some is the King of America? I'll tell you Friend, he reigns above, and doth not
make havoc of mankind like the Royal Brute of Britain. Yet that we may not appear to be
defective even in earthly honors, let a day be solemnly set apart for proclaiming the charter; let
it be brought forth placed on the divine law, the word of God; let a crown be placed thereon, by
which the world may know, that so far as we approve as monarchy, that in America THE LAW IS
KING. For as in absolute governments the King is law, so in free countries the law ought to be
King; and there ought to be no other. But lest any ill use should afterwards arise, let the crown
at the conclusion of the ceremony be demolished, and scattered among the people whose right
it is.
A government of our own is our natural right: And when a man seriously reflects on the
precariousness of human affairs, he will become convinced, that it is infinitely wiser and safer,
to form a constitution of our own in a cool deliberate manner, while we have it in our power,
than to trust such an interesting event to time and chance. If we omit it now, some, Massanello
may hereafter arise, who laying hold of popular disquietudes, may collect together the
desperate and discontented, and by assuming to themselves the powers of government, may
sweep away the liberties of the continent like a deluge. Should the government of America
return again into the hands of Britain, the tottering situation of things, will be a temptation for
some desperate adventurer to try his fortune; and in such a case, what relief can Britain give?
Ere she could hear the news, the fatal business might be done; and ourselves suffering like the
wretched Britons under the oppression of the Conqueror. Ye that oppose independence now,
ye know not what ye do; ye are opening a door to eternal tyranny, by keeping vacant the seat
of government. There are thousands, and tens of thousands, who would think it glorious to
expel from the continent, that barbarous and hellish power, which hath stirred up the Indians
and Negroes to destroy us, the cruelty hath a double guilt, it is dealing brutally by us, and
treacherously by them.
To talk of friendship with those in whom our reason forbids us to have faith, and our affections
wounded through a thousand pores instruct us to detest, is madness and folly. Every day wears
out the little remains of kindred between us and them, and can there be any reason to hope,
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that as the relationship expires, the affection will increase, or that we shall agree better, when
we have ten times more and greater concerns to quarrel over than ever?
Ye that tell us of harmony and reconciliation, can ye restore to us the time that is past? Can ye
give to prostitution its former innocence? Neither can ye reconcile Britain and America. The last
cord now is broken, the people of England are presenting addresses against us. There are
injuries which nature cannot forgive; she would cease to be nature if she did. As well can the
lover forgive the ravisher of his mistress, as the continent forgive the murders of Britain. The
Almighty hath implanted in us these unextinguishable feelings for good and wise purposes.
They are the guardians of his image in our hearts. They distinguish us from the herd of common
animals. The social compact would dissolve, and justice be extirpated from the earth, or have
only a casual existence were we callous to the touches of affection. The robber, and the
murderer, would often escape unpunished, did not the injuries which our tempers sustain,
provoke us into justice.
O ye that love mankind! Ye that dare oppose, not only the tyranny, but the tyrant, stand forth!
Every spot of the old world is overrun with oppression. Freedom hath been hunted round the
globe. Asia, and Africa, have long expelled her. — Europe regards her like a stranger, and
England hath given her warning to depart. O! receive the fugitive, and prepare in time an
asylum for mankind.
29
Address to Congress on Women’s Suffrage
By Carrie Chapman Catt
Delivered November 1917, Washington, D.C.
Woman suffrage is inevitable. Suffragists knew it before November 4, 1917; opponents
afterward. Three distinct causes made it inevitable.
First, the history of our country. Ours is a nation born of revolution, of rebellion against a
system of government so securely entrenched in the customs and traditions of human society
that in 1776 it seemed impregnable. From the beginning of things, nations had been ruled by
kings and for kings, while the people served and paid the cost. The American Revolutionists
boldly proclaimed the heresies: "Taxation without representation is tyranny." "Governments
derive their just powers from the consent of the governed." The colonists won, and the nation
which was established as a result of their victory has held unfailingly that these two
fundamental principles of democratic government are not only the spiritual source of our
national existence but have been our chief historic pride and at all times the sheet anchor of
our liberties.
Eighty years after the Revolution, Abraham Lincoln welded those two maxims into a new one:
"Ours is a government of the people, by the people, and for the people." Fifty years more
passed and the president of the United States, Woodrow Wilson, in a mighty crisis of the
nation, proclaimed to the world: "We are fighting for the things which we have always carried
nearest to our hearts: for democracy, for the right of those who submit to authority to have a
voice in their own government."
All the way between these immortal aphorisms political leaders have declared unabated faith in
their truth. Not one American has arisen to question their logic in the 141 years of our national
existence. However stupidly our country may have evaded the logical application at times, it
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has never swerved from its devotion to the theory of democracy as expressed by those two
axioms.
With such a history behind it, how can our nation escape the logic it has never failed to follow,
when its last unenfranchised class calls for the vote? Behold our Uncle Sam floating the banner
with one hand, "Taxation without representation is tyranny," and with the other seizing the
billions of dollars paid in taxes by women to whom he refuses "representation." Behold him
again, welcoming the boys of twentyone and the newly made immigrant citizen to "a voice in
their own government" while he denies that fundamental right of democracy to thousands of
women public school teachers from whom many of these men learn all they know of citizenship
and patriotism, to women college presidents, to women who preach in our pulpits, interpret
law in our courts, preside over our hospitals, write books and magazines, and serve in every
uplifting moral and social enterprise. Is there a single man who can justify such inequality of
treatment, such outrageous discrimination? Not one.
Second, the suffrage for women already established in the United States makes women
suffrage for the nation inevitable. When Elihu Root, as president of the American Society of
International Law, at the eleventh annual meeting in Washington, April 26, 1917, said, "The
world cannot be half democratic and half autocratic. It must be all democratic or all Prussian.
There can be no compromise," he voiced a general truth. Precisely the same intuition has
already taught the blindest and most hostile foe of woman suffrage that our nation cannot long
continue a condition under which government in half its territory rests upon the consent of half
of the people and in the other half upon the consent of all the people; a condition which grants
representation to the taxed in half of its territory and denies it in the other half a condition
which permits women in some states to share in the election of the president, senators, and
representatives and denies them that privilege in others. It is too obvious to require
demonstration that woman suffrage, now covering half our territory, will eventually be
ordained in all the nation. No one will deny it. The only question left is when and how will it be
completely established.
Third, the leadership of the United States in world democracy compels the enfranchisement of
its own women. The maxims of the Declaration were once called "fundamental principles of
government." They are now called "American principles" or even "Americanisms." They have
become the slogans of every movement toward political liberty the world around, of every
effort to widen the suffrage for men or women in any land. Not a people, race, or class striving
for freedom is there anywhere in the world that has not made our axioms the chief weapon of
the struggle. More, all men and women the world around, with farsighted vision into the
verities of things, know that the world tragedy of our day is not now being waged over the
assassination of an archduke, nor commercial competition, nor national ambitions, nor the
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freedom of the seas. It is a death grapple between the forces which deny and those which
uphold the truths of the Declaration of Independence.
Do you realize that in no other country in the world with democratic tendencies is suffrage so
completely denied as in a considerable number of our own states? There are thirteen black
states where no suffrage for women exists, and fourteen others where suffrage for women is
more limited than in many foreign countries.
Do you realize that when you ask women to take their cause to state referendum you compel
them to do this: that you drive women of education, refinement, achievement, to beg men who
cannot read for their political freedom?
Do you realize that such anomalies as a college president asking her janitor to give her a vote
are overstraining the patience and driving women to desperation?
Do you realize that women in increasing numbers indignantly resent the long delay in their
enfranchisement?
Your party platforms have pledged women suffrage. Then why not be honest, frank friends of
our cause, adopt it in reality as your own, make it a party program, and "fight with us"? As a
party measure a measure of all parties why not put the amendment through Congress and the
legislatures? We shall all be better friends, we shall have a happier nation, we women will be
free to support loyally the party of our choice, and we shall be far prouder of our history.
"There is one thing mightier than kings and armies" aye, than Congresses and political parties
"the power of an idea when its time has come to move." The time for woman suffrage has
come. The woman's hour has struck. If parties prefer to postpone action longer and thus do
battle with this idea, they challenge the inevitable. The idea will not perish; the party which
opposes it may. Every delay, every trick, every political dishonesty from now on will antagonize
the women of the land more and more, and when the party or parties which have so delayed
woman suffrage finally let it come, their sincerity will be doubted and their appeal to the new
voters will be met with suspicion. This is the psychology of the situation. Can you afford the
risk? Think it over.
We know you will meet opposition. There are a few "women haters" left, a few "old males of
the tribe," as Vance Thompson calls them, whose duty they believe it to be to keep women in
the places they have carefully picked out for them. Treitschke, made world famous by war
literature, said some years ago, "Germany, which knows all about Germany and France, knows
far better what is good for AlsaceLorraine than that miserable people can possibly know." A few
American Treitschkes we have who know better than women what is good for them. There are
women, too, with "slave souls" and "clinging vines" for backbones. There are female dolls and
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male dandies. But the world does not wait for such as these, nor does liberty pause to heed the
plaint of men and women with a grouch. She does not wait for those who have a special
interest to serve, nor a selfish reason for depriving other people of freedom. Holding her torch
aloft, liberty is pointing the way onward and upward and saying to America, "Come."
To you and the supporters of our cause in Senate and House, and the number is large, the
suffragists of the nation express their grateful thanks. This address is not meant for you. We are
more truly appreciative of all you have done than any words can express. We ask you to make a
last, hard fight for the amendment during the present session. Since last we asked a vote on
this amendment, your position has been fortified by the addition to suffrage territory of Great
Britain, Canada, and New York.
Some of you have been too indifferent to give more than casual attention to this question. It is
worthy of your immediate consideration. A question big enough to engage the attention of our
allies in wartime is too big a question for you to neglect.
Some of you have grown old in party service. Are you willing that those who take your places by
and by shall blame you for having failed to keep pace with the world and thus having lost for
them a party advantage? Is there any real gain for you, for your party, for your nation by delay?
Do you want to drive the progressive men and women out of your party?
Some of you hold to the doctrine of states' rights as applying to woman suffrage. Adherence to
that theory will keep the United States far behind all other democratic nations upon this
question. A theory which prevents a nation from keeping up with the trend of world progress
cannot be justified.
Gentlemen, we hereby petition you, our only designated representatives, to redress our
grievances by the immediate passage of the Federal Suffrage Amendment and to use your
influence to secure its ratification in your own state, in order that the women of our nation may
be endowed with political freedom before the next presidential election, and that our nation
may resume its world leadership in democracy.
Woman suffrage is coming you know it. Will you, Honorable Senators and Members of the
House of Representatives, help or hinder it?
Transcription by Michael E. Eidenmuller. Property of AmericanRhetoric.com Copyright ©2010. All rights
reserved.
http://www.americanrhetoric.com/speeches/PDFFiles/Carrie%20Chapman%20Catt%20%20Suffrage%20Speech%20to%20Congress.pdf
33
Silent Spring, “A Fable for Tomorrow”
Rachel Carson, 1962
There was once a town in the heart of America where all life seemed to live in harmony with its
surroundings. The town lay in the midst of a checkerboard of prosperous farms, with fields of
grain and hillsides of orchards where, in spring, white clouds of bloom drifted above the green
fields. In autumn, oak and maple and birch set up a blaze of color that flamed and flickered
across a backdrop of pines. Then foxes barked in the hills and deer silently crossed the fields,
half hidden in the mists of the fall mornings.
Along the roads, laurel, viburnum and alder, great ferns and wildflowers delighted the traveler's
eye through much of the year. Even in winter the road- sides were places of beauty, where
countless birds came to feed on the berries and on the seed heads of the dried weeds rising
above the snow. The country- side was, in fact, famous for the abundance and variety of its bird
life, and when the flood of migrants was pouring through in spring and fall people traveled from
great distances to observe them. Others came to fish the streams, which flowed clear and cold
out of the hills and contained shady pools where trout lay. So it had been from the days many
years ago when the first settlers raised their houses, sank their wells, and built their barns.
Then a strange blight crept over the area and everything began to change. Some evil spell had
settled on the community: mysterious maladies swept the flocks of chickens; the cattle and
sheep sickened and died. Everywhere was a shadow of death. The farmers spoke of much
illness among their families. In the town the doctors had become more and more puzzled by
new kinds of sickness appearing among their patients. There had been several sudden and
unexplained deaths, not only among adults but even among children, who would be stricken
suddenly while at play and die within a few hours.
There was a strange stillness. The birds, for example where had they gone? Many people spoke
of them, puzzled and disturbed. The feeding stations in the backyards were deserted. The few
birds seen anywhere were moribund; they trembled violently and could not fly. It was a spring
without voices. On the mornings that had once throbbed with the dawn chorus of robins,
catbirds, doves, jays, wrens, and scores of other bird voices there was now no sound; only
silence lay over the fields and woods and marsh.
On the farms the hens brooded, but no chicks hatched. The farmers complained that they were
unable to raise any pigs the litters were small and the young survived only a few days. The
apple trees were coming into bloom but no bees droned among the blossoms, so there was no
pollination and there would be no fruit.
34
The roadsides, once so attractive, were now lined with browned and 249 withered vegetation
as though swept by fire. These, too, were silent, deserted by all living things. Even the streams
were now lifeless. Anglers no longer Rachel Carson visited them, for all the fish had died.
In the gutters under the eaves and between the shingles of the roofs, a white granular powder
still showed a few patches; some weeks before it had fallen like snow upon the roofs and the
lawns, the fields and streams.
No witchcraft, no enemy action had silenced the rebirth of new life in this stricken world. The
people had done it themselves.
This town does not actually exist, but it might easily have a thousand counterparts in America
or elsewhere in the world. I know of no community that has experienced all the misfortunes I
describe. Yet every one of these disasters has actually happened somewhere, and many real
communities have already suffered a substantial number of them. A grim specter has crept
upon us almost unnoticed, and this imagined tragedy may easily become a stark reality we all
shall know. ...
THE OBLIGATION TO ENDURE
The history of life on earth has been a history of interaction between living things and their
surroundings. To a large extent, the physical form and the habits of the earth's vegetation and
its animal life have been molded by the environment. Considering the whole span of earthly
time, the opposite effect, in which life actually modifies its surroundings, has been relatively
slight. Only within the moment of time represented by the present century has one species
man acquired significant power to alter the nature of his world.
During the past quarter century this power has not only increased to one of disturbing
magnitude but it has changed in character. The most alarming of all man's assaults upon the
environment is the contamination of air, earth, rivers, and sea with dangerous and even lethal
materials. This pollution is for the most part irrecoverable; the chain of evil it initiates not only
in the world that must support life but in living tissues is for the most part irreversible. In this
now universal contamination of the environment, chemicals are the sinister and littlerecognized partners of radiation in changing the very nature of the worldtine very nature of its
life. Strontium 90, released through nuclear explosions into the air, comes to earth in rain or
drifts down as fallout, lodges in soil, enters into the grass or corn or wheat grown there, and in
time takes up its abode in the bones of a human being, there to remain until his death.
Similarly, chemicals sprayed on croplands or forests or gardens lie long in soil, entering into
living organisms, passing from one to another in a chain of poisoning and death. Or they pass
mysteriously by underground streams until they emerge and, through the alchemy of air and
sunlight, combine into new forms that kill vegetation, sicken cattle, and work unknown harm on
35
those who drink from once pure wells. As Albert Schweitzer has said, "Man can hardly even
recognize the devils of his own creation."
It took hundreds of millions of years to produce the life that now inhabits the earth eons of
time in which that developing and evolving and diversifying life reached a state of adjustment
and balance with its surroundings. The environment, rigorously shaping and directing the life it
supported, contained elements that were hostile as well as supporting. Certain rocks gave out
dangerous radiation; even within the light of the sun, from which all life draws its energy, there
were short-wave radiations with power to injure. Given time time not in years but in millennia
life adjusts, and a balance has been reached. For time is the essential ingredient; but in the
modern world there is no time.
The rapidity of change and the speed with which new situations are created follow the
impetuous and heedless pace of man rather than the deliberate pace of nature. Radiation is no
longer merely the background radiation of rocks, the bombardment of cosmic rays, the
ultraviolet of the sun that have existed before there was any life on earth; radiation is now the
unnatural creation of man's tampering with the atom. The chemicals to which life is asked to
make its adjustment are no longer merely the calcium and silica and copper and all the rest of
the minerals washed out of the rocks and carried in rivers to the sea; they are the synthetic
creations of man's inventive mind, brewed in his laboratories, and having no counterparts in
nature.
To adjust to these chemicals would require time on the scale that is nature's; it would require
not merely the years of a man's life but the life of generations. And even this, were it by some
miracle possible, would be futile, for the new chemicals come from our laboratories in an
endless stream; almost five hundred annually find their way into actual use in the United States
alone. The figure is staggering and its implications are not easily grasped500 new chemicals to
which the bodies of men and animals are required somehow to adapt each year, chemicals
totally outside the limits of biologic experience.
Among them are many that are used in man's war against nature. Since the mid-1940's over
200 basic chemicals have been created for use in killing insects, weeds, rodents, and other
organisms described in the modem vernacular as "pests"; and they are sold under several
thousand different brand names.
These sprays, dusts, and aerosols are now applied almost universally to farms, gardens, forests,
and homes nonselective chemicals that have the power to kill every insect, the "good" and the
"bad," to still the song of birds and the leaping of fish in the streams, to coat the leaves with a
deadly film, and to linger on in soil all this though the intended target may be only a few weeds
or insects. Can anyone believe it is possible to lay down such a barrage of poisons on the
36
surface of the earth without making it unfit for all life? They should not be called "insecticides,"
but "biocides."
The whole process of spraying seems caught up in an endless spiral. Since DDT was released for
civilian use, a process of escalation has been going on in which ever more toxic materials must
be found. This has happened becatise insects, in a triumphant vindication of Darwin's principle
of the survival of the fittest, have evolved super races immune to the particular insecticide
used, hence a deadlier one has always to be developed and then a deadlier one than that. It has
happened also because, for reasons to be de- scribed later, destructive insects often undergo a
"flareback," or resurgence, after spraying, in numbers greater than before. Thus the chemical
war is never 251 won, and all life is caught in its violent crossfire.
Along with the possibility of the extinction of mankind by nuclear war, Rachel Carsm the central
problem of our age has therefore become the contamination of man's total environment with
such substances of incredible potential for harm substances that accumulate in the tissues of
plants and animals and even penetrate the germ cells to shatter or alter the very material of
heredity upon which the shape of the future depends. . . .
THE OTHER ROAD
We stand now where two roads diverge. But unlike the roads in Robert Frost's familiar poem,
they are not equally fair. The road we have long been traveling is deceptively easy, a smooth
superhighway on which we progress with great speed, but at its end lies disaster. The other fork
of the road the one "less traveled by" offers our last, our only chance to reach a destination
that assures the preservation of our earth.
The choice, after all, is ours to make. If, having endured much, we have at last asserted our
"right to know," and if, knowing, we have concluded that we are being asked to take senseless
and frightening risks, then we should no longer accept the counsel of those who tell us that we
must fill our world with poisonous chemicals; we should look about and see what other course
is open to us.
A truly extraordinary variety of alternatives to the chemical control of insects is available. Some
are already in use and have achieved brilliant success. Others are in the stage of laboratory
testing. Still others are little more than ideas in the minds of imaginative scientists, waiting for
the opportunity to put them to the test. All have this in common: they are biological solutions,
based on understanding of the living organisms they seek to control, and of the whole fabric of
life to which these organisms belong. Specialists representing various areas of the vast field of
biology are contributing entomologists, pathologists, geneticists, physiologists, biochemists,
ecologists all pouring their knowledge and their creative inspirations into the formation of a
new science of biotic controls. . .
37
Through all these new, imaginative, and creative approaches to the problem of sharing our
earth with other creatures there runs a constant theme, the awareness that we are dealing
with life with living populations and all their pressures and counter pressures, their surges and
recessions. Only by taking account of such life forces and by cautiously seeking to guide them
into channels favorable to ourselves can we hope to achieve a reasonable accommodation
between the insect hordes and ourselves.
The current vogue for poisons has failed utterly to take into account these most fundamental
considerations. As crude a weapon as the cave man's club, the chemical barrage has been
hurled against the fabric of life a fabric on the one hand delicate and destructible, on the other
miraculously tough and resilient, and capable of striking back in unexpected ways. These
extraordinary capacities of life have been ignored by the practitioners of chemical control who
have brought to their task no "high-minded orientation," no humility before the vast forces
with which they tamper.
The "control of nature" is a phrase conceived in arrogance, born of the Neanderthal age of
biology and philosophy, when it was supposed that nature exists for the convenience of man.
The concepts and practices of applied entomology for the most part date from that Stone Age
of science. It is our alarming misfortune that so primitive a science has armed itself with the
most modem and terrible weapons, and that in turning them against the insects it has also
turned them against the earth.
38
“Speech to the Second Virginia Convention”
By Patrick Henry, 1775
“Give Me Liberty Or Give Me Death!"
Colonial Williamsburg Foundation
To avoid interference from Lieutenant-Governor Dunmore and
his Royal Marines, the Second Virginia Convention met March
20, 1775 inland at Richmond--in what is now called St. John's
Church--instead of the Capitol in Williamsburg. Delegate
Patrick Henry presented resolutions to raise a militia, and to
put Virginia in a posture of defense. Henry's opponents urged
caution and patience until the crown replied to Congress' latest
petition for reconciliation.
On the 23rd, Henry presented a proposal to organize a
volunteer company of cavalry or infantry in every Virginia
county. By custom, Henry addressed himself to the
Convention's president, Peyton Randolph of Williamsburg.
Henry's words were not transcribed, but no one who heard them forgot their eloquence, or
Henry's closing words: "Give me liberty, or give me death!"
Henry's first biographer, William Wirt of Maryland, was three-years-old in 1775. An assistant
federal prosecutor in Aaron Burr's trial for treason at Richmond in 1807, and later attorney
general of the United States, Wirt began to collect materials for the biography in 1808, nine
years after Henry's death. From the recollections of men like Thomas Jefferson, Wirt
reconstructed an account of Henry's life, including the remarks presented below.
---------------------------------------------------------------------------------------------------------------------
St. John's Church, Richmond, Virginia
March 23, 1775.
MR. PRESIDENT: No man thinks more highly than I do of the patriotism, as well as abilities, of
the very worthy gentlemen who have just addressed the House. But different men often see
the same subject in different lights; and, therefore, I hope it will not be thought disrespectful to
those gentlemen if, entertaining as I do, opinions of a character very opposite to theirs, I shall
speak forth my sentiments freely, and without reserve. This is no time for ceremony. The
question before the House is one of awful moment to this country. For my own part, I consider
it as nothing less than a question of freedom or slavery; and in proportion to the magnitude of
the subject ought to be the freedom of the debate. It is only in this way that we can hope to
arrive at truth, and fulfil the great responsibility which we hold to God and our country. Should I
keep back my opinions at such a time, through fear of giving offence, I should consider myself
39
as guilty of treason towards my country, and of an act of disloyalty toward the majesty of
heaven, which I revere above all earthly kings.
Mr. President, it is natural to man to indulge in the illusions of hope. We are apt to shut our
eyes against a painful truth, and listen to the song of that siren till she transforms us into
beasts. Is this the part of wise men, engaged in a great and arduous struggle for liberty? Are we
disposed to be of the number of those who, having eyes, see not, and, having ears, hear not,
the things which so nearly concern their temporal salvation? For my part, whatever anguish of
spirit it may cost, I am willing to know the whole truth; to know the worst, and to provide for it.
I have but one lamp by which my feet are guided; and that is the lamp of experience. I know of
no way of judging of the future but by the past. And judging by the past, I wish to know what
there has been in the conduct of the British ministry for the last ten years, to justify those
hopes with which gentlemen have been pleased to solace themselves, and the House? Is it that
insidious smile with which our petition has been lately received? Trust it not, sir; it will prove a
snare to your feet. Suffer not yourselves to be betrayed with a kiss. Ask yourselves how this
gracious reception of our petition comports with these war-like preparations which cover our
waters and darken our land. Are fleets and armies necessary to a work of love and
reconciliation? Have we shown ourselves so unwilling to be reconciled, that force must be
called in to win back our love? Let us not deceive ourselves, sir. These are the implements of
war and subjugation; the last arguments to which kings resort. I ask, gentlemen, sir, what
means this martial array, if its purpose be not to force us to submission? Can gentlemen assign
any other possible motive for it? Has Great Britain any enemy, in this quarter of the world, to
call for all this accumulation of navies and armies? No, sir, she has none. They are meant for us;
they can be meant for no other. They are sent over to bind and rivet upon us those chains
which the British ministry have been so long forging. And what have we to oppose to them?
Shall we try argument? Sir, we have been trying that for the last ten years. Have we anything
new to offer upon the subject? Nothing. We have held the subject up in every light of which it is
capable; but it has been all in vain. Shall we resort to entreaty and humble supplication? What
terms shall we find which have not been already exhausted? Let us not, I beseech you, sir,
deceive ourselves. Sir, we have done everything that could be done, to avert the storm which is
now coming on. We have petitioned; we have remonstrated; we have supplicated; we have
prostrated ourselves before the throne, and have implored its interposition to arrest the
tyrannical hands of the ministry and Parliament. Our petitions have been slighted; our
remonstrances have produced additional violence and insult; our supplications have been
disregarded; and we have been spurned, with contempt, from the foot of the throne. In vain,
after these things, may we indulge the fond hope of peace and reconciliation. There is no
longer any room for hope. If we wish to be free² if we mean to preserve inviolate those
inestimable privileges for which we have been so long contending²if we mean not basely to
abandon the noble struggle in which we have been so long engaged, and which we have
pledged ourselves never to abandon until the glorious object of our contest shall be obtained,
we must fight! I repeat it, sir, we must fight! An appeal to arms and to the God of Hosts is all
that is left us!
40
They tell us, sir, that we are weak; unable to cope with so formidable an adversary. But when
shall we be stronger? Will it be the next week, or the next year? Will it be when we are totally
disarmed, and when a British guard shall be stationed in every house? Shall we gather strength
by irresolution and inaction? Shall we acquire the means of effectual resistance, by lying
supinely on our backs, and hugging the delusive phantom of hope, until our enemies shall have
bound us hand and foot? Sir, we are not weak if we make a proper use of those means which
the God of nature hath placed in our power. Three millions of people, armed in the holy cause
of liberty, and in such a country as that which we possess, are invincible by any force which our
enemy can send against us. Besides, sir, we shall not fight our battles alone. There is a just God
who presides over the destinies of nations; and who will raise up friends to fight our battles for
us. The battle, sir, is not to the strong alone; it is to the vigilant, the active, the brave. Besides,
sir, we have no election. If we were base enough to desire it, it is now too late to retire from
the contest. There is no retreat but in submission and slavery! Our chains are forged! Their
clanking may be heard on the plains of Boston! The war is inevitable²and let it come! I repeat it,
sir, let it come.
It is in vain, sir, to extenuate the matter. Gentlemen may cry, Peace, Peace²but there is no
peace. The war is actually begun! The next gale that sweeps from the north will bring to our
ears the clash of resounding arms! Our brethren are already in the field! Why stand we here
idle? What is it that gentlemen wish? What would they have? Is life so dear, or peace so sweet,
as to be purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what
course others may take; but as for me, give me liberty or give me death!
Source: Wirt, William. Sketches of the Life and Character of Patrick Henry . (Philadelphia) 1836, as
reproduced in The World's Great Speeches, Lewis Copeland and Lawrence W. Lamm, eds., (New York)
1973.
http://www.history.org/almanack/life/politics/giveme.cfm
41
The Stone: “Does Great Literature Make Us Better?”
By Gregory Currie, June 1, 2013, 2:45 pm
The Stone is a forum for contemporary philosophers and other thinkers on issues
both timely and timeless.
You agree with me, I expect, that exposure to challenging works of literary fiction is good for us.
That’s one reason we deplore the dumbing-down of the school curriculum and the rise of the
Internet and its hyperlink culture. Perhaps we don’t all read very much that we would count as
great literature, but we’re apt to feel guilty about not doing so, seeing it as one of the ways we
fall short of excellence. Wouldn’t reading about Anna Karenina, the good folk of Middlemarch
and Marcel and his friends expand our imaginations and refine our moral and social
sensibilities?
If someone now asks you for evidence for this view, I expect you will have one or both of the
following reactions. First, why would anyone need evidence for something so obviously right?
Second, what kind of evidence would he want? Answering the first question is easy: if there’s
no evidence – even indirect evidence – for the civilizing value of literary fiction, we ought not to
assume that it does civilize. Perhaps you think there are questions we can sensibly settle in
ways other than by appeal to evidence: by faith, for instance. But even if there are such
questions, surely no one thinks this is one of them.
What sort of evidence could we present? Well, we can point to specific examples of our fellows
who have become more caring, wiser people through encounters with literature. Indeed, we
are such people ourselves, aren’t we?
There is scant evidence that reading great literature morally improves us.
I hope no one is going to push this line very hard. Everything we know about our understanding
of ourselves suggests that we are not very good at knowing how we got to be the kind of
people we are. In fact we don’t really know, very often, what sorts of people we are. We
regularly attribute our own failures to circumstance and the failures of others to bad character.
But we can’t all be exceptions to the rule (supposing it is a rule) that people do bad things
because they are bad people.
We are poor at knowing why we make the choices we do, and we fail to recognize the tiny
changes in circumstances that can shift us from one choice to another. When it comes to other
people, can you be confident that your intelligent, socially attuned and generous friend who
reads Proust got that way partly because of the reading? Might it not be the other way around:
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that bright, socially competent and empathic people are more likely than others to find
pleasure in the complex representations of human interaction we find in literature?
Graphic by Tucker Nichols
There’s an argument we often hear on the other side, illustrated earlier this year by a piece on
The New Yorker’s Web site. Reminding us of all those cultured Nazis, Teju Cole notes the
willingness of a president who reads novels and poetry to sign weekly drone strike permissions.
What, he asks, became of “literature’s vaunted power to inspire empathy?” I find this a hard
argument to like, and not merely because I am not yet persuaded by the moral case against
drones. No one should be claiming that exposure to literature protects one against moral
temptation absolutely, or that it can reform the truly evil among us. We measure the
43
effectiveness of drugs and other medical interventions by thin margins of success that would
not be visible without sophisticated statistical techniques; why assume literature’s
effectiveness should be any different?
We need to go beyond the appeal to common experience and into the territory of psychological
research, which is sophisticated enough these days to make a start in testing our proposition.
Psychologists have started to do some work in this area, and we have learned a few things so
far. We know that if you get people to read a short, lowering story about a child murder they
will afterward report feeling worse about the world than they otherwise would. Such changes,
which are likely to be very short-term, show that fictions press our buttons; they don’t show
that they refine us emotionally or in any other way.
We have learned that people are apt to pick up (purportedly) factual information stated or
implied as part of a fictional story’s background. Oddly, people are more prone to do that when
the story is set away from home: in a study conducted by Deborah Prentice and colleagues and
published in 1997, Princeton undergraduates retained more from a story when it was set at
Yale than when it was set on their own campus (don’t worry Princetonians, Yalies are just as
bad when you do the test the other way around). Television, with its serial programming, is
good for certain kinds of learning; according to a study from 2001 undertaken for the Kaiser
Foundation, people who regularly watched the show “E.R.” picked up a good bit of medical
information on which they sometimes acted. What we don’t have is compelling evidence that
suggests that people are morally or socially better for reading Tolstoy.
Not nearly enough research has been conducted; nor, I think, is the relevant psychological
evidence just around the corner. Most of the studies undertaken so far don’t draw on serious
literature but on short snatches of fiction devised especially for experimental purposes. Very
few of them address questions about the effects of literature on moral and social development,
far too few for us to conclude that literature either does or doesn’t have positive moral effects.
There is a puzzling mismatch between the strength of opinion on this topic and the state of the
evidence. In fact I suspect it is worse than that; advocates of the view that literature educates
and civilizes don’t overrate the evidence — they don’t even think that evidence comes into it.
While the value of literature ought not to be a matter of faith, it looks as if, for many of us, that
is exactly what it is.
Now, philosophers are careful folk, trained in the ways of argument and, you would hope,
above these failings. It’s odd, then, that some of them write so confidently and passionately
about the kinds of learning we get from literature, and about the features of literature that
make it a particularly apt teacher of moral psychology. In her influential book “Love’s
Knowledge,” Martha Nussbaum argues that the narrative form gives literary fiction a peculiar
44
power to generate moral insight; in the hands of a literary master like Henry James, fiction is
able to give us scenarios that make vivid the details of a moral issue, while allowing us to think
them through without the distortions wrought by personal interest.
I’m not inclined to write off such speculations; it is always good to have in mind a stock of ideas
about ways literature might enhance our thought and action. But it would be refreshing to have
some acknowledgment that suggestions about how literature might aid our learning don’t show
us that it does in fact aid it. (Suppose a schools inspector reported on the efficacy of our
education system by listing ways that teachers might be helping students to learn; the inspector
would be out of a job pretty soon.)
I’m confident we can look forward to better evidence. I’m less optimistic about what the
evidence will show. Here, quickly, is a reason we already have for thinking the idea of moral and
social learning from literature may be misguided.
One reason people like Martha Nussbaum have argued for the benefits of literature is that
literature, or fictional narrative of real quality, deals in complexity. Literature turns us away
from the simple moral rules that so often prove unhelpful when we are confronted with messy
real-life decision making, and gets us ready for the stormy voyage through the social world that
sensitive, discriminating moral agents are supposed to undertake. Literature helps us, in other
words, to be, or to come closer to being, moral “experts.”
The problem with this argument is that there’s long been evidence that much of what we take
for expertise in complex and unpredictable domains – of which morality is surely one – is bogus.
Beginning 50 years ago with work by the psychologist Paul Meehl, study after study has shown
that following simple rules – rules that take account of many fewer factors than an expert
would bother to consider – does at least as well and generally better than relying on an expert’s
judgment. (Not that rules do particularly well either; but they do better than expert judgment.)
Some of the evidence for this view is convincingly presented in Daniel Kahneman’s recent book
“Thinking Fast and Slow”: spectacular failures of expertise include predictions of the future
value of wine, the performance of baseball players, the health of newborn babies and a
couple’s prospects for marital stability.
But why, I hear you say, do you complain about people’s neglect of evidence when you yourself
have no direct evidence that moral expertise fails? After all, no one has done tests in this area.
Well, yes, I grant that in the end the evidence could go in favor of the idea that literature can
make moral experts of us. I also grant that moral thinking is probably not a single domain, but
something that goes on in bewilderingly different ways in different circumstances. Perhaps we
can find kinds of moral reasoning where experts trained partly by exposure to the fictional
45
literature of complex moral choice do better than those who rely on simple moral rules of
thumb.
I haven’t, then, in any way refuted the claim that moral expertise is a quality we should aspire
to. But I do think we have identified a challenge that needs to be met by anyone who seriously
wants to press the case for moral expertise.
Everything depends in the end on whether we can find direct, causal evidence: we need to
show that exposure to literature itself makes some sort of positive difference to the people we
end up being. That will take a lot of careful and insightful psychological research (try designing
an experiment to test the effects of reading “War and Peace,” for example). Meanwhile, most
of us will probably soldier on with a positive view of the improving effects of literature,
supported by nothing more than an airy bed of sentiment.
I have never been persuaded by arguments purporting to show that literature is an arbitrary
category that functions merely as a badge of membership in an elite. There is such a thing as
aesthetic merit, or more likely, aesthetic merits, complicated as they may be to articulate or
impute to any given work.
But it’s hard to avoid the thought that there is something in the anti-elitist’s worry. Many who
enjoy the hard-won pleasures of literature are not content to reap aesthetic rewards from their
reading; they want to insist that the effort makes them more morally enlightened as well. And
that’s just what we don’t know yet.
Gregory Currie is a professor of philosophy at the University of Nottingham.
A version of this article appears in print on 06/02/2013, on page SR12 of the New York edition with
the headline: Does Fiction Civilize Us?.
http://opinionator.blogs.nytimes.com/2013/06/01/does-great-literature-make-usbetter/?_php=true&_type=blogs&_r=0
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“Reading Literature Makes Us Smarter and Nicer”
By Annie Murphy Paul, Time June 3, 2013
Gregory Currie, a professor of philosophy at the University of Nottingham, recently argued in
the New York Times that we ought not to claim that literature improves us as people, because
there is no “compelling evidence that suggests that people are morally or socially better for
reading Tolstoy” or other great books.
Actually, there is such evidence. Raymond Mar, a psychologist at York University in Canada, and
Keith Oatley, a professor emeritus of cognitive psychology at the University of Toronto,
reported in studies published in 2006 and 2009 that individuals who often read fiction appear
to be better able to understand other people, empathize with them and view the world from
their perspective. This link persisted even after the researchers factored in the possibility that
more empathetic individuals might choose to read more novels. A 2010 study by Mar found a
similar result in young children: the more stories they had read to them, the keener their
“theory of mind,” or mental model of other people’s intentions.
“Deep reading” — as opposed to the often superficial reading we do on the Web — is an
endangered practice, one we ought to take steps to preserve as we would a historic building or
a significant work of art. Its disappearance would imperil the intellectual and emotional
development of generations growing up online, as well as the perpetuation of a critical part of
our culture: the novels, poems and other kinds of literature that can be appreciated only by
readers whose brains, quite literally, have been trained to apprehend them.
Recent research in cognitive science, psychology and neuroscience has demonstrated that deep
reading — slow, immersive, rich in sensory detail and emotional and moral complexity — is a
distinctive experience, different in kind from the mere decoding of words. Although deep
reading does not, strictly speaking, require a conventional book, the built-in limits of the
printed page are uniquely conducive to the deep reading experience. A book’s lack of
hyperlinks, for example, frees the reader from making decisions — Should I click on this link or
not? — allowing her to remain fully immersed in the narrative.
That immersion is supported by the way the brain handles language rich in detail, allusion and
metaphor: by creating a mental representation that draws on the same brain regions that
would be active if the scene were unfolding in real life. The emotional situations and moral
dilemmas that are the stuff of literature are also vigorous exercise for the brain, propelling us
inside the heads of fictional characters and even, studies suggest, increasing our real-life
capacity for empathy.
None of this is likely to happen when we’re scrolling through TMZ. Although we call the activity
by the same name, the deep reading of books and the information-driven reading we do on the
Web are very different, both in the experience they produce and in the capacities they develop.
A growing body of evidence suggests that online reading may be less engaging and less
satisfying, even for the “digital natives” for whom it is so familiar. Last month, for example,
Britain’s National Literacy Trust released the results of a study of 34,910 young people aged 8
47
to 16. Researchers reported that 39% of children and teens read daily using electronic devices,
but only 28% read printed materials every day. Those who read only onscreen were three times
less likely to say they enjoy reading very much and a third less likely to have a favorite book.
The study also found that young people who read daily only onscreen were nearly two times
less likely to be above-average readers than those who read daily in print or both in print and
onscreen.
To understand why we should be concerned about how young people read, and not just
whether they’re reading at all, it helps to know something about the way the ability to read
evolved. “Human beings were never born to read,” notes Maryanne Wolf, director of the
Center for Reading and Language Research at Tufts University and author of Proust and the
Squid: The Story and Science of the Reading Brain. Unlike the ability to understand and produce
spoken language, which under normal circumstances will unfold according to a program
dictated by our genes, the ability to read must be painstakingly acquired by each individual. The
“reading circuits” we construct are recruited from structures in the brain that evolved for other
purposes — and these circuits can be feeble or they can be robust, depending on how often
and how vigorously we use them.
The deep reader, protected from distractions and attuned to the nuances of language, enters a
state that psychologist Victor Nell, in a study of the psychology of pleasure reading, likens to a
hypnotic trance. Nell found that when readers are enjoying the experience the most, the pace
of their reading actually slows. The combination of fast, fluent decoding of words and slow,
unhurried progress on the page gives deep readers time to enrich their reading with reflection,
analysis, and their own memories and opinions. It gives them time to establish an intimate
relationship with the author, the two of them engaged in an extended and ardent conversation
like people falling in love.
This is not reading as many young people are coming to know it. Their reading is pragmatic and
instrumental: the difference between what literary critic Frank Kermode calls “carnal reading”
and “spiritual reading.” If we allow our offspring to believe carnal reading is all there is — if we
don’t open the door to spiritual reading, through an early insistence on discipline and practice
— we will have cheated them of an enjoyable, even ecstatic experience they would not
otherwise encounter. And we will have deprived them of an elevating and enlightening
experience that will enlarge them as people. Observing young people’s attachment to digital
devices, some progressive educators and permissive parents talk about needing to “meet kids
where they are,” molding instruction around their onscreen habits. This is mistaken. We need,
rather, to show them someplace they’ve never been, a place only deep reading can take them.
48
“Pearl Harbor Address to the Nation”
Franklin Delano Roosevelt, Delivered December 8, 1941, Washington, D.C.
Mr. Vice President, Mr. Speaker, Members of the Senate, and of the House of Representatives:
Yesterday, December 7th, 1941 -- a date which will live in infamy -- the United States of
America was suddenly and deliberately attacked by naval and air forces of the Empire of Japan.
The United States was at peace with that nation and, at the solicitation of Japan, was still in
conversation with its government and its emperor looking toward the maintenance of peace in
the Pacific.
Indeed, one hour after Japanese air squadrons had commenced bombing in the American island
of Oahu, the Japanese ambassador to the United States and his colleague delivered to our
Secretary of State a formal reply to a recent American message. And while this reply stated that
it seemed useless to continue the existing diplomatic negotiations, it contained no threat or
hint of war or of armed attack.
It will be recorded that the distance of Hawaii from Japan makes it obvious that the attack was
deliberately planned many days or even weeks ago. During the intervening time, the Japanese
government has deliberately sought to deceive the United States by false statements and
expressions of hope for continued peace.
The attack yesterday on the Hawaiian islands has caused severe damage to American naval and
military forces. I regret to tell you that very many American lives have been lost. In addition,
49
American ships have been reported torpedoed on the high seas between San Francisco and
Honolulu.
Yesterday, the Japanese government also launched an attack against Malaya.
Last night, Japanese forces attacked Hong Kong.
Last night, Japanese forces attacked Guam.
Last night, Japanese forces attacked the Philippine Islands.
Last night, the Japanese attacked Wake Island.
And this morning, the Japanese attacked Midway Island.
Japan has, therefore, undertaken a surprise offensive extending
throughout the Pacific area. The facts of yesterday and today
speak for themselves. The people of the United States have
already formed their opinions and well understand the
implications to the very life and safety of our nation.
As Commander in Chief of the Army and Navy, I have directed that all measures be taken for
our defense. But always will our whole nation remember the character of the onslaught against
us.
No matter how long it may take us to overcome this premeditated invasion, the American
people in their righteous might will win through to absolute victory.
I believe that I interpret the will of the Congress and of the people when I assert that we will
not only defend ourselves to the uttermost, but will make it very certain that this form of
treachery shall never again endanger us.
Hostilities exist. There is no blinking at the fact that our people, our territory, and our interests
are in grave danger.
With confidence in our armed forces, with the unbounding determination of our people, we will
gain the inevitable triumph -- so help us God.
I ask that the Congress declare that since the unprovoked and dastardly attack by Japan on
Sunday, December 7th, 1941, a state of war has existed between the United States and the
Japanese empire.
http://www.americanrhetoric.com/speeches/fdrpearlharbor.htm
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“Pearl Harbor Address to the Nation” (Annotated Handwritten Copy)
Franklin Delano Roosevelt, 1941
51
World War II Propaganda Posters
The National World War II Museum
52
(The small yellow print above says, “Stay On The Job”)
http://www.nationalww2museum.org/visit/exhibits/propaganda-posters-exhibit-publicprogramming.html
53
“Henrietta's Dance”
By Rebecca Skloot, Johns Hopkins Magazine, April 2000
Opening photo: Youngest son David Lacks holds a photo of a portrait done of his parents, shortly
before his mother died. (Photo by Bill Denison)
Not long before her death, Henrietta Lacks danced. As the film rolled, her long thin face teased
the camera, flashing a seductive grin as she moved, her eyes locked on the lens. She tilted her
head back and raised her hands, waving them softly in the air before letting them fall to smooth
her curlers. Then the film went blank.
Henrietta danced in Turners Station, a small, segregated Baltimore community where she moved
in 1943. She had come by train from a plantation town in Virginia, leaving her kin behind, most
still picking tobacco long after freedom from slavery. As she sped toward Baltimore, at the age of
23, her husband, David Lacks, waited in their new brick house with a stove that burned gas
instead of wood. Henrietta knew she was heading into a more modern world. What she didn't
know was that less than a decade later, after giving birth to her fifth child, her womb would give
rise to a new age in medicine.
On February 1, 1951, under the cover of a solitary tree, David Lacks stared through the window of
his parked car, watching the rain fall. He and his five children, three still in diapers, sat outside
Hopkins Hospital, waiting for Henrietta. A few days earlier, she had found blood spotting her
underwear. Now, Howard Jones, a Hopkins physician, found a smooth eggplant-hued tumor
glistening under the light on Henrietta's cervix. He touched its surface, shocked by its supple
texture, and Henrietta bled. Jones carefully cut a section of her quarter-sized tumor, sent it to the
lab for a diagnosis, and sent Henrietta home with her family. Then came the news: the tumor was
malignant.
Henrietta returned to Hopkins eight days later. While David and the children waited under the
tree, physicians covered her cervix with radium in an attempt to kill the cancer. But before
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applying the first treatment, a young resident took one more sample. This one went to George
Gey, head of tissue culture research at Hopkins. He and his wife, Margaret, had been searching for
a tool for the study of cancer: a line of human cells that would live indefinitely outside the body. If
they succeeded, they could observe and test human cells in ways they could never do in humans.
Eventually, they could discover the cure for cancer. They were sure of it. After two decades of
failure in their laboratory attempts, the Geys turned their attention to cervical cells, at the
request of Richard TeLinde, then Hopkins chairman of Gynecology. TeLinde wanted cervical cells
for his own research; the Geys wanted any cancer cells they could get. The day George Gey got his
hands on Henrietta Lacks's cells, everything changed. For the Geys, for medicine, and eventually
for the Lackses.
Henrietta Lacks's cells multiplied like nothing anyone had seen. They latched to the sides of test
tubes, consumed the medium around them, and within days, the thin film of cells grew thicker
and thicker. But Henrietta's tumor cells took over her body as quickly as they'd taken over test
tubes. Within months, tumors appeared on almost every organ, and Henrietta moaned from her
bed for the Lord to help her. The day she died, October 4, 1951, George Gey appeared on national
television with a vial of Henrietta's cells. He called them HeLa cells, held them up to the camera,
and said, "It is possible that, from a fundamental study such as this, we will be able to learn a way
by which cancer can be completely wiped out." Gey introduced the nation to his hopes for curing
cancer while Henrietta's body lay in the Hopkins morgue, her toenails shining with a fresh coat of
red polish. And her family knew nothing of any cells.
As a train carrying Henrietta's casket rolled back toward Virginia, her cells shocked Gey with their
strength. The local undertaker met Henrietta's body at the station where, less than a decade
earlier, she had boarded her train to Baltimore. He buried her in an unmarked grave across the
street from her family's tobacco field, behind the house where her mother was born. But in the
Lacks family cemetery, where cattle roam freely when the season's right, folks today don't know
much about HeLa. They don't know that soon after Henrietta's death in 1951, Gey and his
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colleagues used her cells to grow the polio virus that was ravaging children throughout the world.
"It was Henrietta Lacks's cells that embraced the polio virus," says Roland Pattillo, a former fellow
of Gey's, who is now director of gynecologic oncology at Morehouse School of Medicine. "She
made it possible to grow the virus so the vaccine could be developed." That was just the
beginning. Gey and his colleagues went on to develop a test, using HeLa cells, to distinguish
between the many polio strains, some of which had no effect on the human body. Until
researchers knew which strain produced polio's crippling effects, they couldn't know what they
were fighting. Through Henrietta's cells, they found their culprit. With this information, Jonas Salk
and his colleagues in Pittsburgh created a vaccine, and the National Foundation for Infantile
Paralysis established facilities for mass-producing the HeLa cells. They would use them to test the
polio vaccine before its use in humans. In the meantime, Gey shared his resources.
Packaged in small tubes tucked in plastic foam containers, with careful instructions for feeding
and handling, shipments of Henrietta's cells went out to Gey's colleagues around the world. . . to
Minnesota, New York, Chile, Russia. . .the list goes on. Researchers welcomed the gifts, allowing
HeLa to grow. They used the cells to search for a leukemia cure and the cause of cancer, to study
viral growth, protein synthesis, genetic control mechanisms, and the unknown effects of drugs
and radiation. And though Henrietta never traveled farther than from Virginia to Baltimore, her
cells sat in nuclear test sites from America to Japan and multiplied in a space shuttle far above the
Earth. Still, David Lacks and his children hadn't a clue.
"The [only thing] I heard about it was, she had that cancer," David Lacks says. "They called
me, said come up there because she died. They asked me to let them take samples, and I
decided not to let them do it." But the researchers told Lacks they could use his wife's cells to
study cancer. Something that might strike his family again someday. Their studies might
someday help his children and his grandchildren. Lacks was skeptical. But, he thought, if they
want to see how my wife's cancer might affect our children, and get ready to treat them if
they get sick, I guess that might be okay. "My cousins said it wouldn't hurt, so eventually I let
them do it. The [doctors said] it was the fastest growing cancer they'd ever known, and they
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were supposed to tell me about it, to let me know, but I never did hear."
He didn't hear, that is, until a hazy day in 1975, 24 years after Henrietta's death, when his
daughter-in-law went to a friend's house for dinner.
In a two-story brown-brick townhouse in Baltimore, five doors down from her home, Barbara
Lacks, the wife of Henrietta's eldest son, Lawrence, sat down for dinner at her friend
Jasmine's house. The two women had been friends for years, but Barbara had never met
Jasmine's sister or brother-in-law, who came all the way from D.C. for dinner. They gathered
around the mahogany table, surrounded by plants and soft light, and Jackson, Jasmine's
brother-in-law, looked across the table at Barbara.
"You know," he said, "your name sounds so familiar." Jackson was a scientist who spent his
days in a Washington laboratory. "I think I know what it is. . .I've been working with some
cells in my lab; they're from a woman called Henrietta Lacks. Are you related?"
"That's my mother-in-law," Barbara whispered, shaking her head. "She's been dead almost 25
years, what do you mean you're working with her cells?"
Jackson explained. The cells, he told her, had been alive since Henrietta's death and were all
around the world. Actually, by that time, they were standard reference cells--few molecular
scientists hadn't worked with them. Barbara excused herself, thanking him, promising she
would be in touch, and ran home to tell her husband what she'd heard. Your mother's cells,
she told him, they're alive. Lawrence called his father who called his brothers and his sister.
They just couldn't understand. "The question I really had," says Barbara, "the question I kept
asking Jackson was, I wonder why they never mentioned anything to the family. They knew
how to contact us." But, since no one had called in the two decades after Henrietta's death,
instead of continuing to wonder, the Lacks family got on the phone and rang Hopkins
themselves. And they did it at an opportune time. Henrietta's cells, it turned out, had grown
out of control. Some scientists thought her relatives were the only people who could help.
Henrietta's cells were, and still are, some of the strongest cells known to science--they
reproduce an entire generation every 24 hours. "If allowed to grow uninhibited," Howard
Jones and his Hopkins colleagues said in 1971, "[HeLa cells] would have taken over the world
by this time." This strength provided a research workhorse to irradiate, poison, and
manipulate without inflicting harm; but it also meant research labs were only big enough for
one culture: HeLa.
Though it took three decades for the Geys to succeed with their efforts to create a human
cell line, after their success with HeLa, culturing cells became suspiciously easy. Researchers
cultivated tissue samples from their own bodies and the bodies of their families and patients.
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Most grew successfully. Sure, the samples struggled during the first few weeks, or even
months, in culture, but then, suddenly, they flourished. Samples blossomed into full-blown
healthy cell lines with the strength of, well, the HeLa cell.
In 1974, a researcher by the name of Walter Nelson-Rees started what everyone called a
nasty rumor: HeLa cells, he claimed, had infiltrated the world's stock of cell cultures. No one
wanted to believe him. For almost three decades researchers had done complex experiments
on what they thought were breast cells, prostate cells, or placental cells, and suddenly, rumor
had it they'd been working with HeLa cells all along. To believe this would be to believe that
years of work and millions of dollars had, in essence, been wasted.
The truth was, Henrietta's cells had traveled through the air, on hands, or the tips of pipettes,
overpowering any cell cultures they encountered. And researchers had no idea. There was no
way to know which cells were growing in the petri dish. And there was no universally
accepted test for a cell culture's identity. To accept or reject the theory that HeLa cells had
taken over, researchers wanted more evidence. This required detailed information about the
cells' source. But they knew only the barest facts about Henrietta: She was black, she was a
woman, and she was dead.
Though it may have been coincidence, soon after the Lacks children called Hopkins asking
about their mother's cells, letters appeared in their mailboxes. Several Hopkins researchers
wondered, the letters said, if the Lacks family would be willing to donate some blood and
tissue samples. Soon, a nurse circled Barbara Lacks's narrow dining room table with needles,
blood tubes, and slides, gathering samples from the Lackses. From these donations,
researchers would find precious bits of information about Henrietta--like her blood type--that
they could use in their attempts to study her cells.
"[It was] an elegant piece of work," Nelson-Rees told a reporter, "by simple Aristotelian class
logic and pure applied genetics, you could speculate, to a remarkable extent, as to what
Henrietta Lacks's [genetic makeup] was." And this is exactly what the researchers did. But if
you ask the family, you'll get a different story.
"The doctors tested us to see what was in my mother's system, was it hereditary," recalls
Henrietta's son Sonny Lacks. "But that's all they said. They never got in contact with us again.
We contacted them a couple a times, but they said they'd get back at us, then after a while,
we just got tired of calling, so everybody just let it go and went back with their lives." But
every now and then, they wonder if they have the gene that killed their mother.
This point of confusion between what the researchers intended to do with the samples and
what the participants understood their intentions to be is only one of several elements of the
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Lackses' story that points to important ethical questions. Some have yet to find answers.
"There are at least two issues that cases like Mrs. Lacks's raise," says Ruth Faden, executive
director of the Johns Hopkins Bioethics Institute and the Philip Franklin Wagley Professor of
Biomedical Ethics. "One is the question of consent, and the other is what, if anything, is
morally or legally due to a person if something of commercial value is developed from their
cells."
In terms of informed consent, says Faden, "the Lackses' story is a sad commentary on how
the biomedical research community thought about research in the 1950s. But it was not at all
uncommon for physicians to conduct research on patients without their knowledge or
consent. That doesn't make it right. It certainly wasn't right. It was also unfortunately
common." Since the era when Henrietta walked through the doors of Hopkins, the field of
biomedical ethics was born, and with it came regulations about informed consent. Patients
now have something like a legal promise that no physician will take samples without
permission. It's the latter issue, the commodification of human body parts, which is still an
extremely unsettled area of ethics and law in public policy. And for the Lackses, who don't all
have health insurance or the money to afford it, the issue of commercial value in this case is
very unsettled. Unsettled, but with little recourse.
Since the development of the HeLa cells, there's been an explosion of both scientific and
commercial interest in the use of human tissues for research purposes, yet research subjects
generally see none of the returns. "The amazing thing," says Faden, "is that here we are,
almost 50 years later, the capacity to develop commercial products from human tissues is
dramatically greater now than it was then, and we still haven't figured out how to handle it. .
. . In terms of public policy, we're real clear that you can't buy and sell organs, that's illegal.
But you can sell blood. You can sell human eggs and sperm. But you can't sell your kidney.
And apparently, you can't sell your cells, you give those away. So, nothing is very clear, and
there are a lot of deep worries about putting price tags on the human body." This is partially
why the United States has recently launched a Presidential Bioethics Advisory Commission to
address this and related issues.
To this day, members of the Lacks family feel they've been passed over in the story of the
HeLa cells. They know their mother's cells started a medical revolution and are now bought
and sold around the world. They're pretty sure that someone, somewhere, has profited from
their mother's death. They know that someone wasn't related to Henrietta. And their
experience is not well-known. In cases like these, Faden agrees, a good way to begin
addressing this problem is through the telling of a story from which everyone can learn. This
story starts with Henrietta and the origin of the HeLa cells: They were not from Helen Lane or
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Helen Larson, as many publications have mistakenly reported, they were from Henrietta
Lacks, wife of David, mother of five.
Not long before his death, Walter Nelson-Rees, who devoted his career to containing the
spread of HeLa cells, sat in a small chair in front of a television camera. He leaned forward,
lifted his arms, and said, "HeLa will live forever, perhaps." And then he paused, staring
wistfully ahead. "The dance of HeLa continues," he said, "they're all dancing out there
somewhere... the stage is very broad and wide, and the curtain has by no means gone down
on them. The music plays on." And somewhere, with freshly painted toenails and curlers in
her hair, perhaps Henrietta dances with them.
“Henrietta and David Lacks” from Smithsonian Magazine
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The Immortal Life of Henrietta Lacks, Prologue
By Rebecca Skloot, 2010
There’s a photo on my wall of a woman I’ve never met, its left corner torn and patched
together with tape. She looks straight into the camera and smiles, hands on hips, dress suit
neatly pressed, lips painted deep red. It’s the late 1940s and she hasn’t yet reached the age of
thirty. Her light brown skin is smooth, her eyes still young and playful, oblivious to the tumor
growing inside her—a tumor that would leave her five children motherless and change the
future of medicine. Beneath the photo, a caption says her name is “Henrietta Lacks, Helen Lane
or Helen Larson.”
No one knows who took that picture, but it’s appeared hundreds of times in magazines and
science textbooks, on blogs and laboratory walls. She’s usually identified as Helen Lane, but
often she has no name at all. She’s simply called HeLa, the code name given to the world’s first
immortal human cells—her cells, cut from her cervix just months before she died.
Her real name is Henrietta Lacks.
I’ve spent years staring at that photo, wondering what kind of life she led, what happened to
her children, and what she’d think about cells from her cervix living on forever—bought, sold,
packaged, and shipped by the trillions to laboratories around the world. I’ve tried to imagine
how she’d feel knowing that her cells went up in the first space missions to see what would
happen to human cells in zero gravity, or that they helped with some of the most important
advances in medicine: the polio vaccine, chemotherapy, cloning, gene mapping, in vitro
fertilization. I’m pretty sure that she—like most of us—would be shocked to hear that there are
trillions more of her cells growing in laboratories now than there ever were in her body.
There’s no way of knowing exactly how many of Henrietta’s cells are alive today. One scientist
estimates that if you could pile all HeLa cells ever grown onto a scale, they’d weigh more than
50 million metric tons—an inconceivable number, given that an individual cell weighs almost
nothing. Another scientist calculated that if you could lay all HeLa cells ever grown end-to-end,
they’d wrap around the Earth at least three times, spanning more than 350 million feet. In her
prime, Henrietta herself stood only a bit over five feet tall.
I first learned about HeLa cells and the woman behind them in 1988, thirty-seven years after
her death, when I was sixteen and sitting in a community college biology class. My instructor,
Donald Defler, a gnomish balding man, paced at the front of the lecture hall and flipped on an
overhead projector. He pointed to two diagrams that appeared on the wall behind him. They
were schematics of the cell reproduction cycle, but to me they just looked like a neon-colored
mess of arrows, squares, and circles with words I didn’t understand, like “MPF Triggering a
Chain Reaction of Protein Activations.”
I was a kid who’d failed freshman year at the regular public high school because she never
showed up. I’d transferred to an alternative school that offered dream studies instead of
biology, so I was taking Defler’s class for high-school credit, which meant that I was sitting in a
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college lecture hall at sixteen with words likemitosis and kinase inhibitors flying around. I was
completely lost.
“Do we have to memorize everything on those diagrams?” one student yelled.
Yes, Defler said, we had to memorize the diagrams, and yes, they’d be on the test, but that
didn’t matter right then. What he wanted us to understand was that cells are amazing things:
There are about one hundred trillion of them in our bodies, each so small that several thousand
could fit on the period at the end of this sentence. They make up all our tissues—muscle, bone,
blood—which in turn make up our organs.
Under the microscope, a cell looks a lot like a fried egg: It has a white (the cytoplasm) that’s full
of water and proteins to keep it fed, and a yolk (the nucleus) that holds all the genetic
information that makes you you. The cytoplasm buzzes like a New York City street. It’s
crammed full of molecules and vessels endlessly shuttling enzymes and sugars from one part of
the cell to another, pumping water, nutrients, and oxygen in and out of the cell. All the while,
little cytoplasmic factories work 24/7, cranking out sugars, fats, proteins, and energy to keep
the whole thing running and feed the nucleus—the brains of the operation. Inside every
nucleus within each cell in your body, there’s an identical copy of your entire genome. That
genome tells cells when to grow and divide and makes sure they do their jobs, whether that’s
controlling your heartbeat or helping your brain understand the words on this page.
Defler paced the front of the classroom telling us how mitosis—the process of cell division—
makes it possible for embryos to grow into babies, and for our bodies to create new cells for
healing wounds or replenishing blood we’ve lost. It was beautiful, he said, like a perfectly
choreographed dance.
All it takes is one small mistake anywhere in the division process for cells to start growing out of
control, he told us. Just one enzyme misfiring, just one wrong protein activation, and you could
have cancer. Mitosis goes haywire, which is how it spreads.
“We learned that by studying cancer cells in culture,” Defler said. He grinned and spun to face
the board, where he wrote two words in enormous print: HENRIETTA LACKS.
Henrietta died in 1951 from a vicious case of cervical cancer, he told us. But before she died, a
surgeon took samples of her tumor and put them in a petri dish. Scientists had been trying to
keep human cells alive in culture for decades, but they all eventually died. Henrietta’s were
different: they reproduced an entire generation every twenty-four hours, and they never
stopped. They became the first immortal human cells ever grown in a laboratory.
“Henrietta’s cells have now been living outside her body far longer than they ever lived inside
it,” Defler said. If we went to almost any cell culture lab in the world and opened its freezers, he
told us, we’d probably find millions—if not billions—of Henrietta’s cells in small vials on ice.
Her cells were part of research into the genes that cause cancer and those that suppress it; they
helped develop drugs for treating herpes, leukemia, influenza, hemophilia, and Parkinson’s
disease; and they’ve been used to study lactose digestion, sexually transmitted diseases,
appendicitis, human longevity, mosquito mating, and the negative cellular effects of working in
sewers. Their chromosomes and proteins have been studied with such detail and precision that
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scientists know their every quirk. Like guinea pigs and mice, Henrietta’s cells have become the
standard laboratory workhorse.
“HeLa cells were one of the most important things that happened to medicine in the last
hundred years,” Defler said.
Then, matter-of-factly, almost as an afterthought, he said, “She was a black woman.” He erased
her name in one fast swipe and blew the chalk from his hands. Class was over.
As the other students filed out of the room, I sat thinking, That’s it? That’s all we get? There has
to be more to the story.
I followed Defler to his office.
“Where was she from?” I asked. “Did she know how important her cells were? Did she have any
children?”
“I wish I could tell you,” he said, “but no one knows anything about her.”
After class, I ran home and threw myself onto my bed with my biology textbook. I looked up
“cell culture” in the index, and there she was, a small parenthetical:
In culture, cancer cells can go on dividing indefinitely, if they have a continual supply of
nutrients, and thus are said to be “immortal.” A striking example is a cell line that has been
reproducing in culture since 1951. (Cells of this line are called HeLa cells because their original
source was a tumor removed from a woman named Henrietta Lacks.)
That was it. I looked up HeLa in my parents’ encyclopedia, then my dictionary: No Henrietta.
As I graduated from high school and worked my way through college toward a biology degree,
HeLa cells were omnipresent. I heard about them in histology, neurology, pathology; I used
them in experiments on how neighboring cells communicate. But after Mr. Defler, no one
mentioned Henrietta.
When I got my first computer in the mid-nineties and started using the Internet, I searched for
information about her, but found only confused snippets: most sites said her name was Helen
Lane; some said she died in the thirties; others said the forties, fifties, or even sixties. Some said
ovarian cancer killed her, others said breast or cervical cancer.
Eventually I tracked down a few magazine articles about her from the seventies. Ebony quoted
Henrietta’s husband saying, “All I remember is that she had this disease, and right after she
died they called me in the office wanting to get my permission to take a sample of some kind. I
decided not to let them.” Jet said the family was angry—angry that Henrietta’s cells were being
sold for twenty-five dollars a vial, and angry that articles had been published about the cells
without their knowledge. It said, “Pounding in the back of their heads was a gnawing feeling
that science and the press had taken advantage of them.”
The articles all ran photos of Henrietta’s family: her oldest son sitting at his dining room table in
Baltimore, looking at a genetics textbook. Her middle son in military uniform, smiling and
holding a baby. But one picture stood out more than any other: in it, Henrietta’s daughter,
Deborah Lacks, is surrounded by family, everyone smiling, arms around each other, eyes bright
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and excited. Except Deborah. She stands in the foreground looking alone, almost as if someone
pasted her into the photo after the fact. She’s twenty-six years old and beautiful, with short
brown hair and catlike eyes. But those eyes glare at the camera, hard and serious. The caption
said the family had found out just a few months earlier that Henrietta’s cells were still alive, yet
at that point she’d been dead for twenty-five years.
All of the stories mentioned that scientists had begun doing research on Henrietta’s children,
but the Lackses didn’t seem to know what that research was for. They said they were being
tested to see if they had the cancer that killed Henrietta, but according to the reporters,
scientists were studying the Lacks family to learn more about Henrietta’s cells. The stories
quoted her son Lawrence, who wanted to know if the immortality of his mother’s cells meant
that he might live forever too. But one member of the family remained voiceless: Henrietta’s
daughter, Deborah.
As I worked my way through graduate school studying writing, I became fixated on the idea of
someday telling Henrietta’s story. At one point I even called directory assistance in Baltimore
looking for Henrietta’s husband, David Lacks, but he wasn’t listed. I had the idea that I’d write a
book that was a biography of both the cells and the woman they came from—someone’s
daughter, wife, and mother.
I couldn’t have imagined it then, but that phone call would mark the beginning of a decadelong
adventure through scientific laboratories, hospitals, and mental institutions, with a cast of
characters that would include Nobel laureates, grocery store clerks, convicted felons, and a
professional con artist. While trying to make sense of the history of cell culture and the
complicated ethical debate surrounding the use of human tissues in research, I’d be accused of
conspiracy and slammed into a wall both physically and metaphorically, and I’d eventually find
myself on the receiving end of something that looked a lot like an exorcism. I did eventually
meet Deborah, who would turn out to be one of the strongest and most resilient women I’d
ever known. We’d form a deep personal bond, and slowly, without realizing it, I’d become a
character in her story, and she in mine.
Deborah and I came from very different cultures: I grew up white and agnostic in the Pacific
Northwest, my roots half New York Jew and half Midwestern Protestant; Deborah was a deeply
religious black Christian from the South. I tended to leave the room when religion came up in
conversation because it made me uncomfortable; Deborah’s family tended toward preaching,
faith healings, and sometimes voodoo. She grew up in a black neighborhood that was one of
the poorest and most dangerous in the country; I grew up in a safe, quiet middle-class
neighborhood in a predominantly white city and went to high school with a total of two black
students. I was a science journalist who referred to all things supernatural as “woo-woo stuff”;
Deborah believed Henrietta’s spirit lived on in her cells, controlling the life of anyone who
crossed its path. Including me.
“How else do you explain why your science teacher knew her real name when everyone else
called her Helen Lane?” Deborah would say. “She was trying to get your attention.” This
thinking would apply to everything in my life: when I married while writing this book, it was
because Henrietta wanted someone to take care of me while I worked. When I divorced, it was
because she’d decided he was getting in the way of the book. When an editor who insisted I
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take the Lacks family out of the book was injured in a mysterious accident, Deborah said that’s
what happens when you piss Henrietta off.
The Lackses challenged everything I thought I knew about faith, science, journalism, and race.
Ultimately, this book is the result. It’s not only the story of HeLa cells and Henrietta Lacks, but
of Henrietta’s family—particularly Deborah—and their lifelong struggle to make peace with the
existence of those cells, and the science that made them possible.
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“'Immortal cells, moral issues: Case of Henrietta Lacks shows need for ethical component in
health care reform”
By Ruth R. Faden, The Baltimore Sun, February 12, 2010
Much has been written and discussed recently about Henrietta Lacks, the African-American
woman from Virginia whose cancer cells, collected for research 60 years ago -- as she was being
treated for the cervical cancer that took her life -- inexplicably but astoundingly grew in the
laboratory without end. The cells, named HeLa, have contributed to cancer therapies, the polio
vaccine and a myriad of other biomedical advances.
Sadly, in 1951, tissue from patients destined exclusively for biomedical research -- and not, for
example, to diagnose or treat disease -- was commonly taken without their consent, stored and
used by scientists.
Happily, today, consent is regularly obtained to take tissue or other body components for
research purposes. But Mrs. Lacks' story has brought new focus to many tough bioethical and
public policy questions that persist. Chief among these are: What, exactly, should patients be
asked to consent to if the fruits of the research are unpredictable? Should they be
compensated if, years or decades later, institutions, scientists or drug companies benefit
financially? Should each and every subsequent or conceivable use of human tissue require a
separate consent from patients or their families? How do we protect patient privacy in such
situations?
As the new book "The Immortal Life of Henrietta Lacks" reminds us, behind every biological
sample is a human being. And while Henrietta Lacks died a largely anonymous death 60 years
ago, many members of her family still live right here in Baltimore.
What I suspect especially grips many of us about Mrs. Lacks' story, however, is that, although
neither the scientists at Johns Hopkins Hospital nor the institution itself benefited in a direct
financial way from the development and distribution of HeLa (hee-lah) cells, they clearly went
on to make -- and continue to make -- lots of money for some in the biomedical-industrial
complex. At the same time, members of the Lacks family have remained profoundly poor and
unable to afford consistent, basic health care over the years.
The contrast is stunning between the well-endowed world of biomedical research and the
situation of the Lacks family, and it contributes to our unease about the inequities in our society
generally, but especially when it comes to health care.
Even if America developed a system that would guarantee a royalty stream to donors from
anything of commercial value derived from their cells or tissues, the only individuals likely to
receive significant compensation would be the rare exceptions like Henrietta Lacks -- whose
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cells were, and still are, singularly potent and useful in biomedical research. Much more often,
breakthroughs stem from hundreds or thousands of specimens.
On the other hand, we could have a society in which people freely donate their tissue to
research without expectation of compensation because of an understanding that the
treatments and cures that result will benefit us all.
That line of thinking holds that when it comes to improving our health by advancing biomedical
research, all of us are "in this together" -- and donating our cells, blood or other tissue
constitutes an act of communal commitment to the common good. In this scenario, giving
samples of our tissue is similar to giving blood and would require only cursory privacy
protections and a brief consent process.
Many of us believe strongly that this "common good" approach is the one to strive for.
But it also is clear to us that for it to work, it needs to be fair. And as Henrietta Lacks' story
powerfully reminds us, high scientific tides do not raise all boats. In our current system, we
capitalize everything and rely on the promise of profits to fuel biomedical innovation. But some
of the very scientific advances made possible by HeLa cells quite possibly did not benefit her
family members. As with so many others who do not have access to adequate health insurance
or medical care, there was no guarantee that their lives would benefit from the medical
advances made possible by access to human tissues.
In this way, the Henrietta Lacks story touches the very heart of the current debate over health
care reform, and the need for universal coverage and access to care. Her tale, like health care
reform and the ethics of biomedical science, is tied up in how the least of us live.
We need a national conversation about more than health care costs and cost shifting. We need
one about the ethical foundations of access to care and their relationship to biomedical science
-- and what is the right thing to do. It is to be hoped that the newly appointed Presidential
Commission for the Study of Bioethical Issues will get that conversation going.
Meanwhile, the saga of Henrietta Lacks tells us that without genuine health care reform, her
scientific legacy will forever overshadow her human one.
Ruth R. Faden is the director of the Johns Hopkins Berman Institute of Bioethics and the Philip Franklin
Wagley Professor of Biomedical Ethics.
http://articles.baltimoresun.com/2010-02-12/news/bal-op.lacks0212_1_cells-henrietta-tissue
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“Immortal Cells, Enduring Issues”
By Dale Keiger, Johns Hopkins Magazine, June 2, 2010
Illustration by David Plunkert
A young lab assistant attended an autopsy at the Johns Hopkins Hospital morgue on October 4,
1951. The assistant was Mary Kubicek. The autopsy was of a woman who had died at 31 from
the metastasized cervical cancer that had so ravaged her there was scarcely an organ in her
body not riddled with malignancies. Kubicek had never seen a corpse before and tried to avert
her gaze from the face to the hands and feet. That’s when she was startled by the deceased
woman’s chipped red toenail polish. Kubicek later told writer Rebecca Skloot, “When I saw
those toenails, I nearly fainted. I thought, ‘Oh jeez, she’s a real person.’”
The real person was Henrietta Lacks. Much of the American public knows at least the outline of
her story since publication of Skloot’s best-selling book The Immortal Life of Henrietta Lacks.
When Lacks came to Hopkins for treatment of her cancer, a surgeon sliced away small samples
of the malignancy and Lacks’ healthy cervical tissue for George Gey, the director of tissue
culture research at Hopkins. By 1951, Gey was nearly 30 years into a quest to culture
“immortal” cell lines: human cells that would reproduce endlessly in test tubes to provide a
steady supply of cells for medical research. Gey had experienced little but failure when a
Hopkins resident dropped off the pieces of Henrietta’s tissue. Soon after the malignant cells,
labeled “HeLa,” were placed in culture medium by Kubicek, who was Gey’s lab assistant, they
began to reproduce, doubling within 24 hours. They have never stopped. They now live by the
uncountable trillions in laboratories and the inventories of biologics companies throughout the
world, still robust after 60 years and perfect for all sorts of research. The HeLa cell line has been
the foundation of a remarkable number of medical advances, including the polio vaccine, the
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cancer drug tamoxifen, chemotherapy, gene mapping, in vitro fertilization, and treatments for
influenza, leukemia, and Parkinson’s disease.
The Immortal Life of Henrietta Lacks by Rebecca Skloot
Though the science and history in Skloot’s book are fascinating, they are not what has made it a
national best seller. What has resonated with readers are the interwoven narratives of
Henrietta Lacks’ sad life and her daughter Deborah’s pursuit of knowledge about the mother
she never knew. And there is one more thing. Text on the front cover of Skloot’s book reads,
“Doctors took her cells without asking.” The inside flap continues, “Henrietta’s family did not
learn of her ‘immortality’ until more than 20 years after her death, when scientists investigating
HeLa began using her husband and children in research without informed consent. And though
the cells had launched a multimillion-dollar industry that sells human biological materials, her
family never saw any of the profits.” A significant segment of the public harbors a deeply rooted
mistrust of medical research. They do not trust physicians and scientists to be open and honest
with them. They fear that the privacy of their medical records will not be respected. They
believe that someone somewhere is making a lot of money off of drugs and biological products
that were developed using pieces of tissue from people who now are entitled to a piece of the
profits. The Immortal Life of Henrietta Lacks speaks to that skepticism, and above all is the vivid
testament of how the Lackses feel they’ve been treated by physicians, researchers, journalists,
and corporations. The book will not reassure those already suspicious that they are being used.
Skloot says, “The thing that I hear more than anything [from readers] is, ‘We want to know
what’s going on. We don’t want to feel like someone is doing something behind our backs.’”
People want their individual humanity acknowledged and respected. Physicians and scientists
and ethicists know this. They also know that doing the right thing, which can seem so
straightforward to the public, gets more complicated all the time.
69
WHEN LACKS CAME TO Johns Hopkins complaining that she had “a knot” on her womb, she
entered the “colored ward” in the only major hospital in Baltimore that would treat an African
American. She received treatment that did not succeed but was state of the art in 1951.
Simultaneous with her care, researchers at Hopkins and elsewhere were searching for better
ways to diagnose cervical cancer, which was killing 15,000 women per year. They wanted a
method of growing cervical cancer cells in the lab. That dovetailed with George Gey’s quest to
create an immortal cell line. He received tissue samples from every cervical cancer patient who
came through Hopkins’ door, including Lacks. Skloot states in her book that no one asked Lacks
for permission to take some of her tissue for Gey’s research. Documentary evidence of what
was said at her bedside is scant and can be taken either as supporting Skloot’s assertion or
arguing against any retrospective moral judgment. Joann Rodgers, senior adviser for science,
crisis, and executive communications at the School of Medicine, says, “People I’ve talked to
here have told me that physicians and scientists did talk to their patients if they wanted to take
tissue, if they wanted to have them participate in research.” But Skloot has seen the consent
form for Lacks’ treatment, and it does not include any mention of taking tissue for research.
Howard Jones, who was Lacks’ gynecologist at the hospital, told Skloot that he never sought
consent for tissue samples. Present-day researchers at Hopkins acknowledge that in the 1950s,
the very concept of informed consent as it’s now known was not on researchers’ minds. Daniel
Ford, vice dean for clinical investigation at the School of Medicine, observes, “In that era,
researchers got a little carried away with science and sometimes forgot the patient, and
physicians treated patients the same way clinically—it wasn’t shared decision making.” David
Nichols, vice dean for education at the school, adds, “It was a relationship that was utterly
imbalanced with respect to power and privilege. There’s a lingering sense, even today, of this
imbalance, which has deep historical roots.”
Before a procedure at Hopkins, patients now sign a consent form that includes this clause:
“Johns Hopkins may dispose of any tissues or parts that are removed during the procedure.
Johns Hopkins may retain, preserve, or use these tissues or parts for internal teaching or other
educational purposes without my permission, even if these tissues or parts identify me.
However, Johns Hopkins may only use or disclose tissues or parts that identify me for research
with my permission or with approval of a review board governed by federal laws protecting
these activities. If the tissues or parts do not identify me, Johns Hopkins may use them for
scientific (research) purposes without my permission or action by a review board.”
Three things make consent a more complicated matter than simply reading a clause like that
and initialing the form. First, in some cases a patient may be asked to provide a biospecimen—
tissue, a DNA swab, a blood sample—for a specific research project that has been approved by
an institutional review board (IRB) and that requires specific consent. More often, though,
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researchers accumulate biospecimens for future use in research that cannot be specified at the
time of collection. In 1951, someone could have told Henrietta Lacks or her husband that they
wanted cells from Henrietta’s cervix to research a better means of diagnosing her cancer. They
could not have told her that someday science would want her cells for research on the effects
of zero gravity in outer space, or for the study of leukemia or lactose intolerance or longevity or
the mating of mosquitoes, all of which has happened. Chi Van Dang, the School of Medicine’s
vice dean for research, points out that scientists can’t possibly anticipate many types of future
research. He says, “Do we have the trust of the public to say, ‘Look, we have your cells. What
we’ll do with these cells, I can tell you to some extent now, but five or 10 years from now they
could be used in a completely different way. With your permission, we need to have that
flexibility.’” Scientists worry that stringent regulations requiring specific consent for any future
uses of biospecimens could hamstring research.
But a recent court case demonstrates that Dang’s hoped-for flexibility on the part of the public
cannot be assumed. Arizona State University recently settled, for $700,000, a lawsuit brought
by Havasupai Indians after they learned that blood samples donated for a study on diabetes
among tribe members were also used for research on schizophrenia and inbreeding. The
Havasupai hold sacred ancestral stories about their origins in the valley they still inhabit, and
they were particularly offended to learn that their samples were used in research about the
migration of ancient peoples from Asia. They had not been asked if their blood could be used
for those additional purposes, and they sued. Joan Scott, director of Hopkins’ Genetics and
Public Policy Center in Washington, D.C., and a research scientist at the Berman Institute of
Bioethics, says, “People see bits and parts of themselves as bits and parts of themselves, you
know? We find that in the research we’ve done there really is a strong altruistic vein in the
American public, in particular individuals who have diseases. That’s their way of helping
someone not go through the same things they did. [But] what they do expect is transparency
and full disclosure about what’s going to be done with the sample.” Skloot has interviewed
plaintiffs in lawsuits over tissue research: “Over and over again they say, ‘If they had just asked
us, we’d have said yes.’”
The second thing that makes informed consent complicated is the “informed” part. Scientists
making a conscientious effort to secure informed consent must wrestle with translating
complex issues for a lay audience. A section of The Immortal Life of Henrietta Lacks describes
Hopkins researchers, including renowned geneticist Victor McKusick, Med ’46, taking blood
samples from members of the Lacks family in 1976. McKusick and his assistant at the time,
Susan Hsu, were searching for DNA markers that could identify HeLa cells in any lab sample.
They could not recall for Skloot how well they had informed Deborah Lacks about why they
wanted some of her blood. But years later Lacks told Skloot that she believed she had
submitted to a test for cancer. Hsu recalled for Skloot giving David Lacks, Henrietta’s husband, a
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technical explanation of why she wanted to draw blood, using terms like “HLA androgen [sic],”
“genetic marker profile,” and “genotype.” David had a fourth-grade education. Did Hsu inform
him, or baffle him? Says Skloot, “People get this stuff if you can explain it to them clearly. There
is a science literacy problem, but there’s a bigger problem with a lack of communication from
the scientists. If you go to a hospital and you don’t speak English, you’re going to get a
translator—French, Spanish, whatever. If you walk in and you don’t speak science, they’re not
going to call in the science translator who says, ‘Let me help explain this to you.’”
Finally, current consent regulations cover only studies done by researchers who have firsthand
contact with tissue donors. If you are a scientist working with anonymized tissue samples taken
from a repository, that is not considered research on a human subject and no informed consent
is required.
Ruth Faden, director of the Berman Institute, raises one more ethical issue: when to ask for
informed consent. Is it proper, when patients are about to undergo surgery and have to deal
with consent for the operations, to present them with another set of decisions regarding what
might be done with their tissues? Faden recently had surgery to repair her shoulder’s rotator
cuff; she notes that like anyone, she has a finite amount of emotional energy, and in this case
wanted to apply it to thinking clearly about her impending procedure, not what might be done
with some of “the gunk,” as she puts it, that was cleaned out of her shoulder. Says Scott, “How
much are people going to be paying attention? They’re under stress from their condition, then
you’ve got this other thing that you shove underneath their noses.”
IN THE JANUARY 30, 1976, issue of Science, McKusick co-authored a paper, “Genetic
Characteristics of the HeLa Cell.” That paper published the analysis of the blood drawn from
Deborah Lacks and others in her family and listed 43 genetic markers found in the Lackses’
DNA. The paper identified Henrietta and listed family members as “Husband,” “Child 1,” and
“Child 2.” Your DNA reveals who you are in the most fundamental sense—your genetic
abnormalities if you have any, your predisposition to certain diseases such as breast cancer,
whether your parents are really your parents or your sister is really your sister. Today no ethical
researcher would publish the sort of genetic information complete with identifiers that
McKusick published in 1976.
The Immortal Life of Henrietta Lacks reports other examples of violations of the Lackses’
privacy. For example, someone, presumably at Hopkins, gave Henrietta’s medical records to
journalist Michael Gold, who quoted from them in his 1985 book A Conspiracy of Cells: One
Woman’s Immortal Legacy and the Medical Scandal It Caused. According to Skloot, no one in
the Lacks family had ever seen those records or given permission for their release. Gold
included a stomach-churning description of Henrietta’s autopsy. He later told Skloot that he
recalled unsuccessful attempts to contact the family; she quotes him as telling her, “And to be
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honest, the family wasn’t really my focus. . . . I just thought they might make some interesting
color for the scientific story.”
The privacy of medical information remains an ever-growing concern as biomedical research,
both academic and commercial, has burgeoned. In 1999, RAND Corporation estimated, in a
monograph titled Handbook of Human Tissue Sources, that 307.1 million human tissue samples
were stored in various repositories throughout the United States. No doubt that number is
significantly larger today. The term “biobank” has entered the lexicon. A biobank is a collection
of human tissue, like a living database of human cells. National biobanks now exist in Estonia,
Canada, Japan, Latvia, Singapore, Sweden, Iceland, and the United Kingdom. Biobanks have
been created by disease advocacy groups, commercial research companies, and academic
centers such as Howard University, which founded the National Human Genome Center to
foster genomic research on African Americans and African diaspora populations. “Recently,
there’s a biobank on every corner,” says Scott. “That may be a slight exaggeration, but not by
much.”
Geneticists are excited by the prospect of new research made possible by linking genetic
samples in these biobanks to clinical information contained in digitized medical records. This
raises new privacy concerns. Some laboratories and biobanks have procedures that strip the
identifiers from specimens, so that no one knows from whom they came. But linking those
samples to the information contained in medical records databases, while scientifically useful,
may erode some of the privacy safeguards that depend on biospecimens being truly
anonymized. Ford recalls a researcher in Arizona who did an experiment on a 1,000-person
public biodatabase that included genetic and clinical data on each person. “It was said to be deidentified,” Ford says—all identifiers stripped out. “That means it did not have to be approved
by a review board and anybody could access it—detective, lawyer, whatever, OK?” The
researcher took 50 entries selected at random and by cross-referencing the data with other
public information was able to match a person’s name to 47 out of 50.
Medical and genetic records have long lives. Henrietta Lacks’ medical records were made public
again as recently as September 2009 by the authors of an article that appeared in Archives of
Pathology and Laboratory Medicine. One of those authors was Grover Hutchins, a professor of
pathology at the School of Medicine.
AS GENETIC MEDICINE, genomic science, and bioengineering become bigger fields, they
generate more opportunities for profit by commercial enterprises. The public understands that
human biospecimens may be used by scientists purely for the advancement of knowledge and
the development of new medical therapies, but they’re also used by business to generate
profits; through technology transfer, they have the potential to generate profits for universities
as well. Few reviews of The Immortal Life of Henrietta Lacks or stories about its author have
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failed to mention that while Johns Hopkins has never sold, licensed, or patented HeLa cells, a
number of commercial firms have sold them and continue to do so, and none of the proceeds
have ever gone to Henrietta’s descendants. There seems to be no precise accounting of how
much money has been made from HeLa; the near-meaningless figure of “multi-millions” has
been in circulation since publication of Skloot’s book. But the amount is assumed to be
substantial. In the afterword, Skloot writes, “Today, tissue-supply companies range from small
private businesses to huge corporations, like Ardais, which pays the Beth Israel Deaconess
Medical Center, Duke University Medical Center, and many others an undisclosed amount of
money for exclusive access to tissues collected from their patients.” Meanwhile, the public
asks: If a corporation used my tissue sample—a piece of my body—to develop a product that
now generates profits, why am I not entitled to a share of those profits?
Ethicists speak of a “common good model” in which tissue donors are not compensated
because they donated pieces of themselves not in the hope of a future payday but to further
science that contributes to the common good. In this model, the payoff is not in dollars but in
better medicine that someday might cure your disease or repair your injury. All well and good,
but two factors complicate the situation. The first is articulated by Faden: “The hitch with this
vision, which ethically has so much to commend it, is the suppressed moral premise that
everyone will benefit from the advances that will result from this shared agreement to let our
biospecimens be used for science,” says Faden. “This vision of the shared public good
presupposes that all of us really benefit, with the emphasis on all of us. So in the absence of
guaranteed access to a decent level of medical care, the moral justification for that structure
breaks down.” She adds, “One of the really tragic dimensions of the Lacks story is the fact that
her children still experience enormous difficulty getting access to decent medical care.” Says
Skloot, “The truth is, not everyone does benefit. The people who benefit are people with
money. The people it doesn’t help are people like the Lackses, people who do not have money,
minorities. People who historically have been hurt most by research done without their consent
tend to be the ones who do not benefit.”
Second, a biotechnology company or pharmaceutical company does not operate for the
common good; it operates to enrich its investors. That suggests a different equation. If your
labor as an employee contributes to the company’s success, that company owes you a salary.
Why doesn’t the company owe you if it developed a lucrative product from a piece of your
body? And regardless of its contributions to the common good, were a nonprofit medical
center to generate revenue from selling your cells to a corporation like Ardais, wouldn’t you be
entitled to a share?
Researchers and ethicists understand the sentiment behind these questions, but they point out
several complications. Ethicists warn of the commodification of human tissue and the dangers
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of creating a market for body parts, even the tiniest of body parts. Researchers note that
Henrietta Lacks’ story—a scientific breakthrough of immense importance that derived from the
cells of a single person—is extraordinarily rare. Most often, advances in biomedical research
involve hundreds if not tens of thousands of biospecimens, many of which may have been
collected five, seven, 10 years ago. (Almost 60 years ago if they’re HeLa.) How does a research
center or a for-profit company track down all of those donors to pay a royalty or fee? Says
Nichols, the Hopkins vice dean for education, “You can imagine a world in which the
retrospective reporting and notification requirements become so onerous that one is not able
to do science at all, and the potential benefits from discovery are withheld from future patients
because science is forced to grind to a halt. On the other hand, patients have rights that have to
be respected, particularly if there’s commercial value.” If the alternative is to pay for tissue
samples at the time they are taken, in case someone might gain commercially from them in the
future, will nonprofit research centers be able to afford large-scale studies? The public wants its
privacy guaranteed. How do researchers or companies know whom to pay retroactively if
identifiers have been stripped from every specimen used in their research? As yet no one
knows the answers to these questions. One solution, says Dang, is for consent forms to include
a waiver of rights to any financial benefits.
JOHNS HOPKINS MAGAZINE wanted to include the Lacks family in this discussion, but Sonny
Lacks, Henrietta’s son, indicated by way of Skloot that they had spoken to enough journalists
and were disinclined to speak to one more. Over the years some of the Lackses have
complained about a lack of compensation, especially in light of their difficulties paying for
health care. But various family members also have stated they have no desire to impede
research, and they’re proud of the contribution Henrietta has made to science. Much of their
annoyance comes down to a lack of communication. They resent that for years no one told
them about HeLa cells. They believe that they themselves were used in research without
adequate informed consent. They are angry that no one asked before releasing Henrietta’s
medical records or the genetic markers that are as much theirs as Henrietta’s. They would like
to have been acknowledged decades ago by researchers as they have now been acknowledged
by Skloot’s book.
Acknowledgment is not just a courtesy, it’s a basic human need and important in addressing
the power imbalance that people still feel when illness or injury forces them to deal with
medicine, science, and large institutions like hospitals, insurance companies, and the
pharmaceutical industry. The needs of science or institutions can become decoupled from the
needs of individuals. That’s why the public still worries about informed consent, privacy, and
who profits from their participation in research. Dang says, “We need to remind scientists,
physicians, and businesspeople that we have a common goal and that the patient is waiting—
for treatment, for a cure, for humanity, and particularly for hope. We often get lost in our own
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world when there is a disjunction of science and humanity—the self-interested drive for
recognition and glory can lead us down the wrong path that crosses ethical boundaries.”
Says Joann Rodgers, “When people come to a [medical] institution, they are vulnerable. If
you’re sick and you come here for care, we need to be sure there’s always recognition of that
vulnerability.” The vulnerable want medicine and science to acknowledge and respect that they
are people, and not need to be reminded of that, too late, by chipped red nail polish.
Dale Keiger is associate editor of Johns Hopkins Magazine.
http://magazine.jhu.edu/2010/06/immortal-cells-enduring-issues/#sthash.EfuNdavj.dpuf
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“Cracking The Code of the Human Genome: Henrietta Lacks’ ‘Immortal’ Cells”
By Sarah Zielinski, Smithsonian Magazine, January 22, 2010
Journalist Rebecca Skloot’s new book investigates how a poor black tobacco farmer had a
groundbreaking impact on modern medicine.
Medical researchers use laboratory-grown human cells to learn the intricacies of how cells work
and test theories about the causes and treatment of diseases. The cell lines they need are
“immortal”—they can grow indefinitely, be frozen for decades, divided into different batches
and shared among scientists. In 1951, a scientist at Johns Hopkins Hospital in Baltimore,
Maryland, created the first immortal human cell line with a tissue sample taken from a young
black woman with cervical cancer. Those cells, called HeLa cells, quickly became invaluable to
medical research—though their donor remained a mystery for decades. In her new book, The
Immortal Life of Henrietta Lacks, journalist Rebecca Skloot tracks down the story of the source
of the amazing HeLa cells, Henrietta Lacks, and documents the cell line's impact on both
modern medicine and the Lacks family.
Who was Henrietta Lacks?
She was a black tobacco farmer from southern Virginia who got cervical cancer when she was
30. A doctor at Johns Hopkins took a piece of her tumor without telling her and sent it down
the hall to scientists there who had been trying to grow tissues in culture for decades without
success. No one knows why, but her cells never died.
Why are her cells so important?
Henrietta’s cells were the first immortal human cells ever grown in culture. They were essential
to developing the polio vaccine. They went up in the first space missions to see what would
happen to cells in zero gravity. Many scientific landmarks since then have used her cells,
including cloning, gene mapping and in vitro fertilization.
There has been a lot of confusion over the years about the source of HeLa cells. Why?
When the cells were taken, they were given the code name HeLa, for the first two letters in
Henrietta and Lacks. Today, anonymizing samples is a very important part of doing research on
cells. But that wasn’t something doctors worried about much in the 1950s, so they weren’t
terribly careful about her identity. When some members of the press got close to finding
Henrietta’s family, the researcher who’d grown the cells made up a pseudonym—Helen Lane—
to throw the media off track. Other pseudonyms, like Helen Larsen, eventually showed up, too.
Her real name didn’t really leak out into the world until the 1970s.
How did you first get interested in this story?
I first learned about Henrietta in 1988. I was 16 and a student in a community college biology
class. Everybody learns about these cells in basic biology, but what was unique about my
situation was that my teacher actually knew Henrietta’s real name and that she was black. But
that’s all he knew. The moment I heard about her, I became obsessed: Did she have any kids?
What do they think about part of their mother being alive all these years after she died? Years
later, when I started being interested in writing, one of the first stories I imagined myself
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writing was hers. But it wasn’t until I went to grad school that I thought about trying to track
down her family.
How did you win the trust of Henrietta’s family?
Part of it was that I just wouldn’t go away and was determined to tell the story. It took almost a
year even to convince Henrietta’s daughter, Deborah, to talk to me. I knew she was desperate
to learn about her mother. So when I started doing my own research, I’d tell her everything I
found. I went down to Clover, Virginia, where Henrietta was raised, and tracked down her
cousins, then called Deborah and left these stories about Henrietta on her voice mail. Because
part of what I was trying to convey to her was I wasn’t hiding anything, that we could learn
about her mother together. After a year, finally she said, fine, let’s do this thing.
When did her family find out about Henrietta’s cells?
Twenty-five years after Henrietta died, a scientist discovered that many cell cultures thought to
be from other tissue types, including breast and prostate cells, were in fact HeLa cells. It turned
out that HeLa cells could float on dust particles in the air and travel on unwashed hands and
contaminate other cultures. It became an enormous controversy. In the midst of that, one
group of scientists tracked down Henrietta’s relatives to take some samples with hopes that
they could use the family’s DNA to make a map of Henrietta’s genes so they could tell which
cell cultures were HeLa and which weren’t, to begin straightening out the contamination
problem.
So a postdoc called Henrietta’s husband one day. But he had a third-grade education and didn’t
even know what a cell was. The way he understood the phone call was: “We’ve got your wife.
She’s alive in a laboratory. We’ve been doing research on her for the last 25 years. And now we
have to test your kids to see if they have cancer.” Which wasn’t what the researcher said at all.
The scientists didn’t know that the family didn’t understand. From that point on, though, the
family got sucked into this world of research they didn’t understand, and the cells, in a sense,
took over their lives.
How did they do that?
This was most true for Henrietta’s daughter. Deborah never knew her mother; she was an
infant when Henrietta died. She had always wanted to know who her mother was but no one
ever talked about Henrietta. So when Deborah found out that this part of her mother was still
alive she became desperate to understand what that meant: Did it hurt her mother when
scientists injected her cells with viruses and toxins? Had scientists cloned her mother? And
could those cells help scientists tell her about her mother, like what her favorite color was and
if she liked to dance.
Deborah’s brothers, though, didn’t think much about the cells until they found out there was
money involved. HeLa cells were the first human biological materials ever bought and sold,
which helped launch a multi-billion-dollar industry. When Deborah’s brothers found out that
people were selling vials of their mother’s cells, and that the family didn’t get any of the
resulting money, they got very angry. Henrietta’s family has lived in poverty most of their lives,
and many of them can’t afford health insurance. One of her sons was homeless and living on
the streets of Baltimore. So the family launched a campaign to get some of what they felt they
were owed financially. It consumed their lives in that way.
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What are the lessons from this book?
For scientists, one of the lessons is that there are human beings behind every biological sample
used in the laboratory. So much of science today revolves around using human biological tissue
of some kind. For scientists, cells are often just like tubes or fruit flies—they’re just inanimate
tools that are always there in the lab. The people behind those samples often have their own
thoughts and feelings about what should happen to their tissues, but they’re usually left out of
the equation.
And for the rest of us?
The story of HeLa cells and what happened with Henrietta has often been held up as an
example of a racist white scientist doing something malicious to a black woman. But that’s not
accurate. The real story is much more subtle and complicated. What is very true about science
is that there are human beings behind it and sometimes even with the best of intentions things
go wrong.
One of the things I don’t want people to take from the story is the idea that tissue culture is
bad. So much of medicine today depends on tissue culture. HIV tests, many basic drugs, all of
our vaccines—we would have none of that if it wasn’t for scientists collecting cells from people
and growing them. And the need for these cells is going to get greater, not less. Instead of
saying we don’t want that to happen, we just need to look at how it can happen in a way that
everyone is OK with.
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The Sunflowers Quilting Bee at Arles By Faith Ringgold
http://www.philamuseum.org/collections/permanent/90056.html
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“Women”
By Alice Walker
They were women then
My mama’s generation
Husky of voice—stout of
Step
With fists as well as
Hands
How they battered down
Doors
And ironed
Starched white
Shirts
How they led
Armies
Headragged generals
Across mined
Fields
Booby-trapped
Ditches
To discover books
Desks
A place for us
How they knew what we
Must know
Without knowing a page
Of it
Themselves.
http://www.nexuslearning.net/books/holt_elementsoflit-3/Collection%2010/women.htm
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Informed Consent
American Cancer Society
Patients and their families are key partners in their health care. When you go for medical
care, you usually get recommendations about needed treatment. Most people follow these
recommendations, but they are not required to do so. If you are an adult and you are able
to make your own decisions, you are the only person who can choose whether to get
treatment and which treatment to get. This is done through a process called informed
consent.
All medical care requires the consent of the patient (or someone who is authorized to
consent for the patient) before the care plan is carried out. In some cases, you approve or
agree with the doctor’s plan by simply getting a prescription filled, allowing blood to be
drawn for lab tests, or seeing a specialist. This is called simple consent, and is OK for
treatments that carry little risk for you. Often times, though, the more careful process of
informed consent is required.
What is informed consent and what does it involve?
In cases where there are larger possible risks, you may be asked to agree in writing to the
doctor’s plan for your care. This is part of informed consent. It recognizes your need to
know about a procedure, surgery, or treatment, before you decide whether to have it.
It’s common to go through the informed consent process before starting cancer treatment.
If you are getting more than one type of treatment, you will likely need separate informed
consents for surgery, chemotherapy, and radiation.
After your first talk with your doctor, you may have only a general idea of the treatment
plan. You’ll likely want to know more so that you can think about the ways this plan may
affect your health and your life. In order to freely decide whether the risks are worth the
benefits you expect to get from the treatment plan, you must understand the risks and
drawbacks of the plan. Most people find that they need to get some questions answered
before they can decide on a treatment plan that carries some risk for them.
Informed consent is a process that includes all of these steps:
• You are told (or get information in some way) about the possible risks and benefits of the
treatment.
• You are told about the risks and benefits of other options, including not getting treatment.
• You have the chance to ask questions and get them answered to your satisfaction.
• You have had time (if needed) to discuss the plan with family or advisors.
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• You are able to use the information to make a decision that you think is in your own best
interest.
• You share your decision with your doctor or treatment team.
If you have gone through these steps and decide to agree to the treatment or procedure, you
are usually asked to sign a paper called a consent form. The completed and signed consent
form is a legal document that lets your doctor go ahead with the treatment plan. The consent
form names the procedure or treatment to be done. The rest of the form may be very general,
stating only that you have been told about the risks of the treatment and other available
options. Or it may be very detailed, outlining what the risks and other options are. Depending
on how it’s presented, you may sign for one certain procedure or treatment, or you may give
blanket approval for any treatments and procedures that the health provider decides are
needed.
From the doctor’s viewpoint, informed consent means that:
• A doctor or nurse must make every effort to be sure the patient understands the purpose,
benefits, risks, and other options of the test or treatment. Then the doctor or nurse must get
the patient’s consent before starting. In some cases, even a simple blood test or an injection
(“shot”) requires written consent from the patient.
• As long as adult patients are mentally able to make their own decisions, medical care cannot
begin unless they give informed consent.
• If the patient is a minor (under age), has a serious mental disability, or cannot give consent,
then the parent, legal guardian, or a person authorized by the court must give consent before
treatment can start. This is usually a close family member who has reason to know what the
patient would want. (See “Who besides the patient can give consent?” in the section “What are
the legal requirements of informed consent?”) As some very public court cases have shown, an
elaborate legal system is in place to guide cases in which the patient is mentally or physically
unable to give informed consent for treatment. These cases have come up when the patient is
in a coma (unconscious) or on life support.
Sometimes health care workers refer to the consent form itself as an “informed consent.” This
is not quite accurate. Informed consent is the process and actions that take place as you learn
about and think about a treatment before you agree to it. Your signature on the form is taken
to be evidence that this took place. If you decide that you do not want the procedure or
treatment, you should not sign the consent form. In this case, you may be asked to sign an
informed refusal form or a form that states you are choosing not to follow medical advice. Your
signature on this form implies that you know the risks of refusing, so be sure that you
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understand these risks and know your other options before you sign. (See the section called
“What if I don’t want the treatment being offered?”)
Why does the doctor need me to sign a consent form?
The main purpose of the informed consent process is to protect the patient. As mentioned
earlier, a capable adult cannot be forced to take any type of medical treatment. In general,
anything other than a life-threatening emergency in which the patient is unconscious requires
consent before treatment. Even in that situation, consent may sometimes be required if the
patient is known to have an advance directive. (See “Who besides the patient can give
consent?” in the next section.)
For simple diagnostic tests and situations in which consent is implied by your actions, a consent
form is not needed. For example, if you see your doctor and allow a blood sample to be taken
for lab tests, your consent is assumed because you went to the doctor seeking care and allowed
the blood to be drawn. At any point, you could change your mind and decide to refuse testing,
leave the doctor’s office, or seek care elsewhere. This is different from a treatment that puts
you in a vulnerable position or can possibly cause serious harm. You need more information
about more risky treatments so that you can weigh your options and consider your risks before
making a decision.
Even when there are no other accepted medical treatment options, it’s still your right as a
competent adult to refuse a treatment that you do not want or refuse to be in a study that you
didn’t choose. But once you sign the consent form, it’s taken to be your formal, legal agreement
that you are OK with the plan or procedure that’s listed on the form unless you revoke (take
back) your consent before treatment is given. The doctor or facility will usually give you a copy
of the consent form, but they keep the original as a legal record that you agreed to the
treatment.
What are the legal requirements of informed consent?
States have developed informed consent laws to govern certain types of communication
between health providers and patients. These laws list the types of information that patients
must be given so they can make an informed decision about having medical care, diagnostic
tests, or treatment.
These laws apply to doctors and sometimes to nurses. They vary from state to state. Some
states have very specific laws about certain situations. For instance, some states dictate certain
information be given about breast cancer treatment or for clinical trials (scientific studies of
promising new treatments). Another difference is that some states call only for “reasonable”
information; but others require “full and complete disclosure.” (Disclosure means making
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information known.) If you want to check with your state to find out more about the laws
where you live, see the section called “How can I find out more?”
In general, informed consent assumes that you are legally able to make your own decisions. If
you are not, the person who is legally allowed to make decisions for you goes through the same
process on your behalf (see “Who besides the patient is allowed to consent?” below).
For informed consent to take place, the information that is given must be understood. This
responsibility is shared by the patient, since the doctor won’t know what you don’t understand
unless you ask about it. The patient must have the chance to consider the information and ask
questions.
And finally, informed consent assumes that when you make your decision, you are not
pressured—you freely choose based on what you feel is best for you.
Informed consent for a clinical trial is usually required to be more detailed and thorough than
consent for a standard medical procedure or treatment. This is because there’s a bigger chance
of unknown effects with new treatments, and it’s even more important that you know about
these possibilities. (See the section, “How is informed consent for a clinical trial or research
study different from consent for standard treatment?”)
Who besides the patient is allowed to consent?
For children or others who are unable to make the decision for themselves, the parent or legal
guardian is legally responsible for getting the information, making the decision, and signing the
consent form. But that doesn’t mean that the child or patient who is not considered mentally
competent is always left out of the process. Some facilities require the assent of older children
before they go into a research study, even after the parents have agreed on the child’s behalf.
Assent means that, even though the parents sign the form, the child must also be OK with it
before the facility will do the treatment.
Along the same lines, people who are unable to manage their daily affairs due to impaired
thinking or emotional problems may still be able to understand the medical situation and make
their wishes known. They should be given information in a way they can understand, and asked
what they want to do.
In the event that you become unable to take in information and make your wishes known,
another person may be asked to take part in the process of informed consent. There are several
ways that person can be chosen. The only way you can choose the person to make these
decisions for you is to set up a durable power of attorney for health care (also called a health
care power of attorney). In this case, if you are unable to speak for yourself, the person you
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chose becomes legally responsible for making medical decisions on your behalf. This person is
sometimes called your proxy, agent, or surrogate. A few states restrict the ability of your proxy
to carry out certain requests. For more on health care powers of attorney, see our information,
Advance Directives. (You can read it on our Web site, or you can call us for a copy.)
Another option is a court-appointed surrogate or proxy. This is someone a judge chooses to
make medical decisions for you. If you become unable to make decisions for yourself, someone
else – such as the doctor, facility, a friend, or a family member – may ask (petition) the court to
appoint someone to do it for you. The process varies from state to state.
Many states have passed family agency acts that choose which family members (in a listed
order of priority) may act on behalf of a person who cannot speak for her- or himself. This
option may be used if you don’t have an advance directive or court appointed proxy. Depending
on your family situation and which state you are in, that person may be your legal guardian,
spouse, parent, child, sibling, or other relative.
Are there times when the usual consent requirements do not apply?
In general, those who make decisions must be legally recognized as adults in the state where
treatment is given. But there are a few times when an older teen (for instance, one who is selfsupporting and doesn’t live at home, is married, or in the military) does not need parental
consent for procedures or treatments. There are also some situations where teens can consent
for certain kinds of treatment even if they are underage. The rules and treatment situations
vary from state to state.
There are also times when the decision made by the parent or guardian of a child or an
incompetent adult may be challenged by the doctor or facility. In these cases, the courts may
overrule the usual decision-maker if they think the decision that was made would cause undue
harm. But these cases are fairly rare.
In an emergency, if a person is unconscious and in danger of death or other serious outcome if
medical care is not given right away, informed consent may not be required before treatment.
If those who are giving treatment know that the patient has an advance directive refusing the
care, the treatment may not be given. If those treating the person know that he or she has an
advance directive that appoints someone else to make decisions, that person may be called for
informed consent if there is time. But in general, emergency situations don’t allow much time
to check on advance directives.
How will I be given information for an informed consent?
The way in which information about the treatment must be given (for example, verbally or in
writing) may be listed in your state’s laws. Other methods such as videos, audio files, interactive
computer modules, booklets, fact sheets, etc may be used by your doctor or facility to make the
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information easier to understand. The most important thing is that you understand and are
allowed to get answers to your questions, so that you have all the information you need as you
consider your decision.
Sometimes, a person other than the doctor who will be giving the treatment is asked to give
you the information for your informed consent. If this person is unable to answer your
questions to your satisfaction, you may want to wait to sign the consent form until you can talk
to someone who can answer your questions more completely.
How much detail should I expect?
Material information: Informed consent requires disclosure of “material” (significant or
important) information that will help the patient make an informed choice. The law defines
material information in 2 ways:
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The professional’s point of view: In this view, the health provider’s responsibility is limited
to telling you those things that a health professional who works in your community would
tell you under the same or similar circumstances.
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The patient’s point of view: A patient-oriented standard of disclosure means that the health
provider must tell you all the facts, risks, and alternatives that a reasonable person in your
situation would find important in deciding whether to have a recommended treatment.
Some of the material information a patient wants may not be available. For example, the longterm risks of a new method of treatment may not be known. If this is the case, the spirit of the
laws of informed consent require the health provider to give the best answer possible, which
may be “we don’t know that yet.”
Limited knowledge shouldn’t stop you from asking questions at whatever level of detail you
want. Some people want to know as much as possible about their treatment or procedure
before they agree to it, while others want to know very little. Again, the doctor may not have all
the information you’d like, but at least you can find out more about what is and isn’t known.
What if I am having trouble understanding the information?
Informed consent is not only the health provider’s responsibility. It’s your job to be sure that
you understand the information you have been given, even if it means going over the
information many times.
Sometimes health care workers use words that are very hard to understand. Ask the doctor to
define words and explain terms. Be sure to tell him or her what you understand and what you
don’t. Sometimes it helps to have a nurse, social worker, or patient advocate with you. They
may be able to re- phrase and explain things in ways that are clearer to you.
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If you are facing an important health decision, it may be also helpful to bring a spouse, relative,
or friend with you. That way, there will be a second listener to help process the information and
ask questions.
What questions should I ask during informed consent?
You will, of course, have your own questions, especially once the doctor starts sharing
information. But some basic questions you might ask include:
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What is my diagnosis (the medical name for the illness I have) and what does that mean?
How serious is my diagnosis?
What treatments are recommended?
Are there other treatment options? What are they?
What benefits would you expect from the recommended treatments and the other options?
What are the risks or complications of the recommended treatment and the other
treatment options?
Are there problems or side effects that may be caused by the treatments?
What methods will be used to prevent or relieve these problems or side effects?
What are the side effects of the treatment—immediate, short-term, and long-term?
How will having treatment affect my normal functions and everyday activities?
How would not having treatment affect my normal functions and everyday activities?
How long will treatment last?
How long will it be before I can go back to my normal activities?
How much does the treatment cost?
Will my insurance cover it? How much can I expect to pay?
It’s a good idea to write down your questions and bring the list to your appointments, take
notes on the responses, or bring a voice recorder to record the discussion. (You will want to
check with the doctor before you record your talks.) Good health providers usually appreciate a
patient’s efforts to understand the challenges they face and to make informed decisions.
How long does the informed consent process take?
The entire informed consent process can take place in one short visit for a fairly simple
procedure about which you have few questions. On the other hand, it may take 2 or more
conversations for something more complex. For instance, if you are looking at more than one
treatment option, a long course of treatment, or a clinical trial, it may take some time.
In fact, even after you have signed up for a clinical trial and signed a consent form, the
researchers running the trial should keep you updated about new information that affects you
as a volunteer. This is part of an ongoing informed consent process, which can sometimes go on
even after the clinical trial ends.
Can I change my mind after I’ve signed the consent?
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You can change your mind at any time, even if you’ve already started treatment. Most consent
forms mention that you also have the right to stop treatment or withdraw from a study even
after you have signed a consent form. Even if the form does not mention it, you still have this
right. You would need to contact the doctor in charge of your treatment or the clinical trial to
make your wishes known. You may be asked to sign a form refusing further treatment so that
the doctor or facility will have a legal record (see the next section, “What if I don’t want the
treatment that is being offered?”).
What if I don’t want the treatment that is being offered?
Part of the informed consent process includes letting you ask questions about other treatments
that may help you or other options that you may prefer. You may choose other options, even if
they are not as well proven as the one your doctor recommends. And you may refuse a certain
treatment, surgery, or procedure without refusing all care. For instance, you may choose to
refuse surgery but still wish to be treated for infection or pain. Keep in mind that your doctor is
not required to go along with your plan, though. It may be up to you to find someone who will
treat you with such an approach, so you may need to seek care elsewhere—with another
doctor or facility.
As mentioned earlier, if you are competent to make your own medical decisions, you have the
right to refuse any and all medical treatment and diagnostic procedures. Even if not treating the
disease or condition means that the person will die, US courts have mostly agreed that patients
have the right to reject treatment.
If you have decided to refuse treatment or diagnostic tests, the health provider may inform you
of the risks or likely outcomes of this choice so that you can make an informed refusal. The
doctor or facility may ask you to sign a form that states you received this information, and that
you still choose not to be treated. If you don’t want to sign the form, the doctor may ask
witnesses to sign that you were so informed.
How is informed consent for a clinical trial or research study different from consent for
standard treatment?
Informed consent for a clinical trial or investigational drug or procedure (where new treatments
are compared to the current standard treatment) usually includes more information than the
consent for standard treatment. The informed consent process should tell you:
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What the clinical trial is set up to find out
What is expected of you—what will be done and how long you will take part
Expected benefits
What’s known and not known about the new drug or procedure
Any possible risks to you (if known)
Whom you should contact with questions about or problems with the study
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Other possible treatment options
That you can leave the study with no penalty and opt for standard medical care at any time
How your personal information will be protected
The informed consent process is meant to give you ongoing explanations that will help you
make educated decisions about whether to start or stay in a clinical trial. The most important
part of this process is your everyday interaction and discussions with the research team and
other medical staff before, during, and after the trial. The consent form can be a great tool to
help get this conversation started.
This is all done so that you can make the best decision for yourself, and to be sure that you are
able to choose freely whether to enroll in or stay in the study. Much of this information may be
on the consent form itself, which also usually explains that you can withdraw from the study at
any time without penalty. The doctor or nurse may encourage you to take extra time to think it
over and come back with any questions. If you are giving consent for your child, both parents
may be required to sign the form in order for your child to take part in the clinical trial.
Before you decide, the research team will talk with you about the clinical trial’s purpose,
procedures, risks, possible benefits, and your rights as a participant. If you decide to take part,
the team will keep you up to date on any new information that may affect you and your
situation. Before, during, and even after the clinical trial, you will have the chance to ask
questions and talk about your concerns. Informed consent for clinical trials goes on for as long
as the research lasts, and even afterward.
The process varies among different research institutions and clinical centers, but normally
informed consent includes these steps:
A first meeting. This is when you meet with a member of the research team who gives you the
informed consent document and explains it to you. This discussion may also include your
oncologist (cancer specialist), primary care doctor, and a nurse. Sometimes a social worker,
patient representative, or staff psychologist may be there, too. You can bring along a family
member or friend for support, and to help you keep track of the information. The information
should be given in a way you can understand. It should also be given at a comfortable pace,
with time allowed for you to think it over and ask questions. Some centers offer a video, audio
recording, or even an interactive computer module to help you better understand the
information in the consent form.
Time to take in the information. It can be hard to absorb this much new information in one
sitting, especially at a time of emotional stress. You should be given a copy of the consent form
so that that you can take it home; review it as many times as you need; and talk it over with
family, friends, clergy, counselors, therapists, patient representatives, or other trusted advisors.
A check of your understanding of the information. The research team should make every
effort to be sure that you understand the information they give you. They can do this by having
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you fill out a questionnaire, asking you questions, or having you tell them about the clinical trial
in your own words. You also should tell team members about anything you do not understand.
If you find that the consent form or other information is written in words that are too technical
for you, let them know. Otherwise they will likely assume that you understand when you really
don’t.
Chances to ask questions. During the first meeting and in later discussions, you should be given
the chance to ask questions and raise concerns. Keep asking questions until you know enough
to make your decision.
Continued updates on new information. As the clinical trial goes on, the research team may
make new discoveries that could affect your health, wellbeing, or willingness to stay in the
study. They will share this with you and may ask you to sign a new consent form. Of course, you
are free to leave the study if this information leads you to have doubts about staying in it.
A contact person and phone number for more information should be given to you at the first
meeting. While your doctor is likely to be a helpful source of information, only you can make
the decision about being in a study. Not even the best medical experts can predict whether a
treatment, screening, prevention, or supportive care method being studied in a clinical trial will
work for you. The informed consent process is designed to help you weigh all of the pros and
cons and make the best choice for you or your child.
Tips about clinical trials
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Keep a copy of the consent form. Ask for a copy if one isn’t offered to you. You may also
request a copy of the protocol (full study plan) that describes all the details of the clinical
trial.
According to US regulations, no informed consent document may say anything that asks or
seems to ask you to give up (waive) any legal rights. It also may not include anything that
releases or appears to release the investigator, doctor, sponsor, or facility from liability if
they are negligent or careless.
If you cannot understand the forms you are asked to sign, don’t be afraid to let someone
know that you are having trouble. Many people feel nervous about signing consent forms
and talking with doctors. Take your time, and ask for help when you need it.
How is shared decision-making different from informed consent?
In shared decision-making and informed consent, you get information about treatment, and
you get to make the final decision about whether you want treatment. But shared decisionmaking takes informed consent a step further, giving the patient more responsibility.
Shared decision-making is a newer way of talking about treatment and treatment decisions,
and some doctors are using it. It works like this: the doctor gives the patient information about
the pros and cons of all the treatment options, including no treatment. This often involves
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“homework” for the patient, such as reading, looking at DVDs, or sifting through other types of
information. The patient tells the doctor about factors (preferences, problems, home
conditions, etc.) that might make each treatment option better or worse than the others. The
patient and doctor then make the decision together about which treatment is best for the
patient. Or they may decide on something else, such as waiting for further developments
before choosing a treatment.
This is quite different from just saying “yes” or “no” to the treatment the doctor offers you. It
may mean that you must take in more information, ask more questions, share more about
yourself, and take more time to sort through your options together. This type of decisionmaking is especially helpful when there is no single “best” treatment option. For many people,
the extra effort is worth it—they feel more certain that they made the best treatment choice
for themselves. But for others, it may be too much or feel overwhelming (see the next section
called “What if I want my doctor to make the decisions about my care…?).
It’s OK to tell the doctor that you don’t want a shared decision. But if you do want this kind of
input into your medical decisions, let your doctor know. Be sure that you understand all the
reasonable options for your situation, and go over them with your doctor. See the section
called “What questions should I ask during informed consent?” to get some ideas of what to ask
about each treatment option. Keep in mind that your doctor may not have as much information
about some treatments as others, and you may need to get a second opinion to get a more
complete picture.
What if I want my doctor to make the decisions about my care, and I don’t want more
information?
Some people prefer not to know a great deal about their diagnosis or treatment. Just as you
have a right to informed consent, you have a right to refuse information. Or you can ask for
only minimal information and trust your health provider to make decisions for you. At the same
time, informed consent laws do not allow a health provider to keep a diagnosis from the
patient, even at the family’s request. If you wish to refuse information in today’s legal
environment, a wise health care provider will likely require you to put that in writing in the
form of a waiver or other document.
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“The Nuremberg Code”
The United States Department of Health and Human Services
1. The voluntary consent of the human subject is absolutely essential.
This means that the person involved should have legal capacity to give consent; should be so
situated as to be able to exercise free power of choice, without the intervention of any element
of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion;
and should have sufficient knowledge and comprehension of the elements of the subject
matter involved, as to enable him to make an understanding and enlightened decision. This
latter element requires that, before the acceptance of an affirmative decision by the
experimental subject, there should be made known to him the nature, duration, and purpose of
the experiment; the method and means by which it is to be conducted; all inconveniences and
hazards reasonably to be expected; and the effects upon his health or person, which may
possibly come from his participation in the experiment.
The duty and responsibility for ascertaining the quality of the consent rests upon each
individual who initiates, directs or engages in the experiment. It is a personal duty and
responsibility which may not be delegated to another with impunity.
2. The experiment should be such as to yield fruitful results for the good of society,
unprocurable by other methods or means of study, and not random and unnecessary in
nature.
3. The experiment should be so designed and based on the results of animal
experimentation and a knowledge of the natural history of the disease or other problem
under study, that the anticipated results will justify the performance of the experiment.
4. The experiment should be so conducted as to avoid all unnecessary physical and mental
suffering and injury.
5. No experiment should be conducted, where there is an apriori reason to believe that
death or disabling injury will occur; except, perhaps, in those experiments where the
experimental physicians also serve as subjects.
6. The degree of risk to be taken should never exceed that determined by the
humanitarian importance of the problem to be solved by the experiment.
7. Proper preparations should be made and adequate facilities provided to protect the
experimental subject against even remote possibilities of injury, disability, or death.
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8. The experiment should be conducted only by scientifically qualified persons. The highest
degree of skill and care should be required through all stages of the experiment of those
who conduct or engage in the experiment.
9. During the course of the experiment, the human subject should be at liberty to bring the
experiment to an end, if he has reached the physical or mental state, where
continuation of the experiment seemed to him to be impossible.
10. During the course of the experiment, the scientist in charge must be prepared to
terminate the experiment at any stage, if he has probable cause to believe, in the
exercise of the good faith, superior skill and careful judgement required of him, that a
continuation of the experiment is likely to result in injury, disability, or death to the
experimental subject.
"Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10",
Vol. 2, pp. 181-182. Washington, D.C.: U.S. Government Printing Office, 1949.]
http://www.hhs.gov/ohrp/archive/nurcode.html
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“Principles of Medical Ethics”
American Medical Association
Preamble
The medical profession has long subscribed to a body of ethical statements developed primarily
for the benefit of the patient. As a member of this profession, a physician must recognize
responsibility to patients first and foremost, as well as to society, to other health professionals,
and to self. The following Principles adopted by the American Medical Association are not laws,
but standards of conduct which define the essentials of honorable behavior for the physician.
Principles of medical ethics
I. A physician shall be dedicated to providing competent medical care, with compassion and
respect for human dignity and rights.
II. A physician shall uphold the standards of professionalism, be honest in all professional
interactions, and strive to report physicians deficient in character or competence, or engaging
in fraud or deception, to appropriate entities.
III. A physician shall respect the law and also recognize a responsibility to seek changes in those
requirements which are contrary to the best interests of the patient.
IV. A physician shall respect the rights of patients, colleagues, and other health professionals,
and shall safeguard patient confidences and privacy within the constraints of the law.
V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a
commitment to medical education, make relevant information available to patients, colleagues,
and the public, obtain consultation, and use the talents of other health professionals when
indicated.
VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free
to choose whom to serve, with whom to associate, and the environment in which to provide
medical care.
VII. A physician shall recognize a responsibility to participate in activities contributing to the
improvement of the community and the betterment of public health.
VIII. A physician shall, while caring for a patient, regard responsibility to the patient as
paramount.
IX. A physician shall support access to medical care for all people.
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