The Nuremberg Code is not just for prosecuting Nazis; its principles have shaped medical ethics to this day

After World War II, Nuremberg, Germany, was the site of trials of Nazi officials accused of war crimes and crimes against humanity. The Nuremberg Trials were a milestone in the development of international law. But one of them has also been used in peacetime: the ‘Medical trial”, which has since contributed to the formation of bioethics.

Twenty Nazi doctors and three administrators were tried for involvement deadly and torturous human experimentsincluding freezing prisoners in ice water and subjecting them to simulated experiments at high altitudes. Other Nazi experiments included infecting prisoners with malaria, typhoid and poisons and subjecting them to mustard gas and sterilization. These criminal experiments were usually carried out in the concentration camps and often ended with the death of the test subjects.

Lead prosecutor Telford Taylor, a U.S. attorney and general in the U.S. Army, argued that such lethal experiments were more accurate classified as murder and torture than everything that has to do with medical practice. A review of the evidence, including medical expert witnesses And testimonies from camp survivorsled to the judges agreeing. The sentences were pronounced on August 20, 1947.

As part of their ruling, the American judges drew up a draft that became known as The Nuremberg Codewhich sets out the key requirements for ethical treatment and medical research. The code is widely recognized, among other things, because it is the first major articulation of the doctrine of informed consent. Still, the guidelines from this study may not be enough to protect people today from new, potentially ‘species-threatening’ research.

Ten core values

The code consists of 10 principles that the judges ruled that both a matter of medical ethics and a matter of international human rights law must be followed.

The first and most famous sentence stands out: “The voluntary consent of the human subject is absolutely essential.”

In addition to voluntary and informed consent, the code also requires that subjects have the right to withdraw from an experiment at any time. The other provisions are intended to protect the health of the subjects, including that the research must be done only by a qualified researcher, must follow sound science, be based on preliminary research on animals and provide adequate protection of health and safety of the test subjects must guarantee.

The prosecutors, doctors and trial judges created the code by working together. As they did, so did they setting the early agenda for a new field: bioethics. The guidelines also describe a scientist-subject relationship that requires researchers to do more than act in what they believe to be the best interests of the subjects, but to respect the human subject’s human rights and protect their well-being. These rules essentially replace the paternalistic model of the Hippocratic Oath with a human rights approach.

Under President Dwight D. Eisenhower, who had been the commanding general in Europe, the U.S. Department of Defense has adopted the principles of the code in 1953 – a sign of his influence. The fundamental principle of consent is also summarized in the UN Convention International Covenant on Civil and Political Rightsdeclaring that “no person shall be subjected to medical or scientific experimentation without his free consent.”

Still, some doctors tried to distance themselves from the Nuremberg Code because its source was legal rather than medical, and because they did not want to be in any way associated with the Nazi doctors on trial at Nuremberg.

This was formulated by the World Medical Association, a doctors’ group that was founded after the Nuremberg doctors’ trial its own set of ethical guidelinescalled the “Declaration of HelsinkiAs with Hippocrates, Helsinki allowed exceptions to informed consent, for example when the physician-researcher believed that silence was in the best medical interest of the subject.

The Nuremberg Code was written by judges to be applied in court. Helinski is written by doctors for doctors.

There have been no further international trials on human experimentation since Nuremberg, not even by the International Criminal Court, so the text of the Nuremberg Code remains unchanged.

New research, new procedures?

The code has been an important point of attention my work in the field of health law and bioethicsand I spoke in Nuremberg on the occasion of the country’s 50th and 75th anniversaries, at conferences sponsored by the International Physicians for the Prevention of Nuclear War. Both events celebrated the Nuremberg Code as a proclamation of human rights.

I remain a strong supporter of the Nuremberg Code and believe that following its precepts is both an ethical and legal obligation for physician researchers. Yet the public cannot expect Nuremberg to protect the country against all forms of scientific research or weapons development.

Shortly after the US dropped atomic bombs over Hiroshima and Nagasaki – two years before the Nuremberg trials began – it became clear that our species was capable of destroying ourselves.

Nuclear weapons are just one example. Most recently, international debate has focused on new potential pandemics, but also on gain-of-function research, which sometimes adds lethality to an existing bacteria or virus to make it more dangerous. The goal is not to harm people, but rather to try to develop a protective countermeasure. The danger, of course, is that a super-harmful agent ‘escapes’ from the laboratory before such a countermeasure can be developed.

I agree with the critics who argue that at least some gain-of-function research is so dangerous to our species that it should be banned altogether. Innovations in artificial intelligence and climate technology can also pose deadly dangers to all people, not just some people. Our next question is who gets to decide whether research on endangered species should be conducted, and on what basis?

I believe that species endangerment research should require multinational, democratic debate and approval. Such a mechanism would be a way to make the survival of our own endangered species more likely – and ensure that we can celebrate the 100th anniversary of the Nuremberg Code.

This article is republished from The conversation under a Creative Commons license. Read the original article.