STOP READING! STOP RIGHT NOW! DO NOT READ ANY FURTHER! Unless you have already seen Tim Wardle’s new documentary “Three Identical Strangers.” In that event, you have my permission to read on. Otherwise, stop and go see the movie. This post contains spoilers and this movie should not be spoiled.
Assuming that you have already seen the movie, you know (as I did not when I went to see it), that it is the riveting tale of three triplets who, somewhat miraculously, found each other in 1980, 19 years after they had been adopted out to three separate families who were not told that the babies they were receiving had two identical siblings. The reunion scenes are heartwarming as we watch the brothers fall in love with one another and marvel at their similarities even after they were separated for nearly two decades. Drama follows. They drink too deeply at the trough of fame. They open a restaurant named Triplet’s, which begins well but creates pressures. All three marry. One commits suicide.
Somewhere along the way, it dawned on the families that the adoption agency had not told them that that each child had two twin brothers. With a little research, they learned that the separation had been part of an experiment regarding the eternal debate on the influence of nature vs. nurture. One of the brothers had been placed with a wealthy family, one with a middle class family, and one with a blue collar family. They were tracked and repeatedly tested as they developed. And, it turns out, the experiment also involved several sets of identical twins who also were adopted out without their families being told of their siblings. Some of the twins eventually ran into each other; some were never reunited.
The experiment was run by the estimable Dr. Peter Neubauer, Clinical Professor of Psychiatry at NYU, former secretary general of the International Association of Child Psychiatry and Allied Professions, and former president of the Association for Child Psychoanalysis.
One of my friends who saw the movie was horrified at the immorality of the experimenters who separated siblings in the interests of science. Another said that in judging morality, you have to take the time into account. This experiment was launched in 1961, roughly the same era as the Milgram obedience experiments and the Stanford prison experiment. That should be considered, I admit, but sometimes you just end up on the wrong side of history.
My thought experiment for today is this: What would Dr. Neubauer have done if he had used Dr. Deni Elliott’s Systematic Moral Analysis (SMA) to evaluate the morality of his study before he launched it? (See our Concepts Unwrapped video on SMA.)
SMA Step 1 asks: Who is likely to be harmed and how? Dr. Elliott lists ten moral rules to apply in this inquiry. Seven are framed negatively: Do not kill, cause pain, disable, deprive of freedom, deprive of pleasure, deceive, or cheat. Three are framed as positive duties: keep your promises, obey the law, do your duty. As applied to the triplets, it seems obvious that, at a minimum, the triplets suffered harm. They were deprived of the pleasure of knowing and loving their siblings. The movie contains hints that the three each suffered mental problems as teens. The families’ theory is that they suffered from separation anxiety caused by being separated after being in the same womb for nine months and the same crib for six more before the adoptions. The triplets were also deceived into thinking they did not have blood siblings. The experiment definitely caused harm.
Step 2 involves determining whether someone is morally responsible for the harm. There seems no question that this experiment was Dr. Neubauer’s responsibility. He had, again using Elliott’s terminology, role-related responsibilities (RRR). He did receive the assistance of the adoption agency and sent out his graduate students and others to track and test the triplets as they grew, but the responsibility was clearly his.
SMA’s Step 3 asks: Can the action be justified? Many questions can be asked to explore this issue, but three important ones, drawn from one of Dr. Elliott’s lists, would be: Is harm being avoided or prevented that justifies the harm caused? Are benefits being promoted that justify the harm caused? If there are people of unequal power involved, have you chosen an action that cares best for the most vulnerable?
Regarding harm avoided, when questioned by the triplets’ families, the adoption agency claimed that the triplets had been separated because it is harder to place twins and triplets than single children. Thus, the agency argued that it was avoiding the harm of the triplets growing up with neither birth parents nor adoptive parents. However, even if it is easier to place singletons: (a) this wasn’t the true reason they were separated, and (b) “harder” does not mean impossible or even particularly difficult.
Turning to potential justifying benefits, as a researcher, Dr. Neubauer certainly believed that the nature vs. nurture debate was an incredibly important one. Twin studies are a powerful means of exploring this issue. It is quite possible that in Neubauer’s mind, the harm to the triplets (and the twins) seemed justified by the scientific insights that could be gained. An objective third party might well disagree. I know that I do. Dr. Neubauer was dealing with just one set of triplets and a couple of handfuls of separated twins. Did he really think that such a small study, even carefully done, would settle the nature vs. nurture debate? Did he believe the study could contribute enough new knowledge to justify the harm to the subjects? My layman’s conclusion is that only extreme hubris could have led him to think that. And he was wrong, we now know, because he never published the results of the study and donated the study’s data to Yale on condition that it be kept secret until 2066.
Did Dr. Neubauer protect the most vulnerable? Decidedly not.
Finally, SMA would encourage Dr. Neubauer to consider alternative courses of action. I am not a creative person and not a researcher in child psychiatry or child development, but I have difficulty thinking up an alternative that would have given Dr. Neubauer the information he desired without exploiting, harming, and deceiving the triplets.
Had he applied SMA, Dr. Neubauer should have decided not to carry out this study that caused the triplets to miss out on 19 years of life that they could have had together. As it happens, the “Ethical Standards of Psychologists” in place in 1961 (promulgated in 1959) seem to lead to the same conclusion. Regarding research, the standards provided, in part:
- “Only when a problem is significant and can be investigated in no other way is the psychologist justified in giving misinformation to research subjects or exposing research subjects to physical or emotional stress.”
- “When the possibility of serious aftereffects exists, research is conducted only when the subjects or their responsible agents are fully informed of this possibility and volunteer nevertheless.”
- “The psychologist seriously considers the possible harmful aftereffects and removes them as soon as permitted by the design of the experiment.”
This study lacked consent. It carried the potential and the reality of aftereffects. Nothing was done to mitigate those effects until the study was stopped, coincidentally, when the triplets discovered each other and great publicity ensued. The termination of the study also coincided with issuance of the Belmont Report on human subject research, which might have brought home to Dr. Neubauer just how morally problematic this study was.
SMA is just one framework for determining the morality of a particular course of action, but it is a good one. Whether we use SMA or professional standards, it is difficult to do anything other than condemn this study even though it led to this fascinating and thought-provoking movie. Too much harm was done.
As a postscript, in an article in the Los Angeles Times, director Tim Wardle admitted that he was concerned about the effect the movie could have on the two surviving brothers who during interviews had to relive some very painful times, including the suicide of their sibling. Wardle said: “Because of their background, it threw up a lot of ethical considerations for us.” I recommend SMA for movie directors as well.
American Psychiatric Association, The Principles of Medical Ethics (2013), available at https://www.google.com/search?q=ethical+standards+of+psychiatrists&ie=utf-8&oe=utf-8&client=firefox-b-1.
American Psychological Association, Ethical Standards of Psychologists, 14 The American Psychologist 279 (1959).
American Psychological Association, Ethical Principles of Psychologists and Code of Conduct, available at http://www.apa.org/ethics/code/ (2002, as amended).
Deni Elliott, Ethics in the First Person: A Guide to Teaching and Learning Practical Ethics (2007).
Deni Elliott, Ethical Challenges: Building an Ethics Toolkit (2008).
Deni Elliott, Ethical Challenges PDF, available at: http://www.academia.edu/35600873/Ethical_Challenges_PDF.pdf.
Amy Kaufman, “The Surreal, Sad Story Behind the Acclaimed New Doc ‘Three Identical Strangers,’” Los Angeles Times, July 1, 2018.
Anthony Lane, “Like Family,” New Yorker, July 2, 2018, p. 71.
The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report (1970), available at https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html.
Deborah Smith, “Five Principles for Research Ethics,” APA Monitor, Jan. 2003, p. 56.
Richard Whittaker, “Twins, Genes, and Destiny: Lawrence Wright Meets Three Identical Strangers,” Austin Chronicle, July 23, 2018.
Lawrence Wright, Twins and What They Tell Us About Who We Are (1998).
Ethics Unwrapped Concepts Unwrapped Video on Systematic Moral Analysis: https://ethicsunwrapped.utexas.edu/video/systematic-moral-analysis.