HISTORICAL CONTEXT

 

Historical context and Implications

The Nuremberg trials that took place in the aftermath of World War II sought to prosecute prominent members of Nazi Germany for their involvement in the Holocaust and other war crimes. These trials provided one of the earliest instances of international law, leaving behind a legacy that paved the way for the advancement of modern law.

Within the Nuremberg Trials there were 23 defendants accused of being involved in various medical crimes committed by the Nazi Party. This included human experimentation, and mass murder under the guise of euthanasia. The decisions made by the presiding judges provided an avenue through which the consideration of ethics and ethical treatment was brought to light.  This led to the development and implementation of what is now known as the ‘Nuremberg Code’, a list of ten basic principles of ethics that the court contended were universally accepted by those involved in human experimentation.²

The Nuremberg Code drafted at the end of the Doctor’s Trial in 1947 marked a significant event on the timeline of medical history. Prior to its development, there was no universally accepted set of rules or guidelines relating to the methods and treatment found within human experimentation. Some countries did have established national policies relating to the topic, however, including Russia and Germany. Nonetheless, the Nuremberg Code has since served as a foundation for ethical clinical research, acting as a cornerstone in the medical world.² The Declaration of Helsinki, originally adopted in Finland in 1964 and currently one of the most influential pieces of writing regarding human experimentation, built upon the ideas that were developed over the course and conclusion of the Nuremberg Doctor’s Trial.

Prior to the appearance of the Nuremberg Code, there were few notable instances of ethical regulations relating to informed consent and human experimentation. In 1900 the Prussian government issued a directive to all clinics and hospitals, one which appeared to acknowledge the ideas of informed consent and ethical treatment.¹ However, little is known about the so-called ‘Berlin Code’ and it wasn’t until 1931 that ethical considerations once again came into the spotlight. The Reich government in Germany issued a set of six detailed guidelines which clearly stated the difference between therapeutic and non-therapeutic research. Known as the 1931 Guidelines they set out strict precautions for those in the medical profession in Germany, in what was one of the earliest instances of a legal doctrine of informed consent.³ As such, it can be seen that while the Nuremberg Code was of great importance in relation to human ethical codes it was by no means the very first exploration into the subject. It has been subject to critique from medical experts all around the world.

Michael Marrus (1999) explores the Nuremburg Doctor’s Trial through placing a particular emphasis on the time and setting. While the importance of the outcome of this trial is well known, Marrus shifts focus onto the manner in which the trail was held and the multitude of issues that arose. The trial took place with a ‘hastily assembled’ group of 25 attorneys, who were both ‘overworked and understaffed’ (Marrus 1999 pp. 110). Marrus (1999) claims that the nature of the trial was to demonstrate a link between the atrocious crimes committed and the wider Nazi regime, rather than to achieve justice and set a precedent for medical crime. As such, the focus was shifted away from ethical considerations. This can be perfectly seen through reference to the forced sterilization of thousands of people between 1934 and 1945. The Doctor’s Trial purely focused on crimes committed during the war period, practically ignoring the previous years of pain imposed on German civilians. Furthermore, the systematic euthanasia of the Jewish and the disabled was addressed to horrifying detail yet the explanation put forth by the Doctor’s Trial was severely lacking (Marrus 1999).

This critique by Marrus (1999) adopts a consistent view that there is much that the Nuremberg Doctor’s Trial did not achieve. While it is true that several basic concepts were greatly improved upon, such as the issue of informed consent, the trial failed to acknowledge several seemingly key points. Eugenic thought is one of these points clearly seen within the Nazi medical world yet more or less ignored during the trial. It failed to elucidate the racist and eugenic policies that were in place in Germany at the time.

References:

¹Ghooi, Ravindra B. 2011. “The Nuremberg Code-A Critique”. Perspectives In Clinical Research 2 (2): 72. doi:10.4103/2229-3485.80371.

²Marrus, Michael R. 1999. “The Nuremberg Doctors’ Trial In Historical Context”. Bulletin Of The History Of Medicine 73 (1): 106-123. doi:10.1353/bhm.1999.0037.

³Vollmann, J. and R. Winau. 1996. “Informed Consent In Human Experimentation Before The Nuremberg Code”. BMJ 313 (7070): 1445-1447. doi:10.1136/bmj.313.7070.1445.