LITERATURE REVIEW

Historiographical analyses

The Second World War was the largest war in history; beginning in September 1939 when the Germans invaded Poland and ending with the surrender of Japan in September 1945.⁷ The German attack on Poland triggered the declaration of war on Germany by Britain, France, Canada, Australia, New Zealand and the Union of South Africa.⁷ During this time, Nazi Germany built a range of detention facilities to imprison and eliminate those considered ‘enemies of the state’ for purposes such as forced labour, mass murder and medical experimentation.⁵

Some of the atrocities committed in these concentration camps included placing victims in low-pressure chambers which simulated high altitudes or in chilled seawater to mimic the environmental conditions German soldiers could potentially encounter and thus observe how long one would survive.¹ However, for the few that were fortunate enough to survive these extreme conditions, they were likely killed later so autopsies could be performed.

Furthermore, a multitude of individuals were deliberately exposed to hepatitis, malaria and typhus. Some were forced to inhale and/or swallow mustard gas. Numerous incarcerated inmates had their skins coated with incendiary phosphorus which was then ignited and many had their wounds deliberately injected with pus to induce gas gangrene. Bodily incisions were also made so that bacteria and fragments of wood or glass could be inserted. Similarly, entire limbs and parts of bones were removed from healthy inmates to transplant into other individuals.¹

Another significant Nazi experiment conducted stemmed from the goal to sterilise as many women as possible without their knowledge. Some of this was carried out via radiation techniques whereas other women had caustic substances injected into the uterus and fallopian tubes during routine gynaecological examinations.²

Physicians were paramount in the execution of the Nazi experiments. Some argue that the physicians’ support of the procedures practiced on those incarcerated gave scientific legitimacy to the principles of eugenics and was consequently used to rationalise the murders under the presumed logic of medical necessity. Thus, it is argued that the Nazi regime could not have achieved the aims it did had physicians failed to provide their support as the doctors ultimately disguised the atrocities occurring by not only systematising them, but masking them in misleading medical jargon.³

That said, for many looking retrospectively back on the atrocities that occurred, it is almost unfathomable to believe that such inhumane acts were perpetrated. Indeed, there have been conflicting opinions, interpretations and myriad attempts put forward to explain the reasoning and motives behind the Nazi doctors’ participation in such inhumane acts. Views which suggest that all Nazi doctors were psychopaths themselves or ones which illustrate that the physicians did not have free will and were forced into conducting the experiments, are far less supported.³ Instead, Colaianni (2016), argues that Nazis utilised the hierarchy and power of socialisation to enlist physicians by calling upon young doctors to do their ‘national duty’ as ‘soldiers’.³ Indeed, he reveals that by enabling doctors to make the final decision which regarding which individuals were ‘fit’ enough to live, murder became a medical procedure that was systematised, sanitised and sanctioned.³ Additionally, it is argued that Nazi doctors were able to justify the pain and suffering they inflicted on millions of people using the same logic that modern doctors use when putting patients through painful procedures; “I am a doctor and I want to preserve life. And out of respect for human life, I would remove a gangrenous appendix from a diseased body. The Jew is the gangrenous appendix in the body of mankind” (Colaianni, 2016 pp. 437) and many of the defendants argued that they engaged in necessary wartime medical research.⁴

The Nuremberg trial stretched from the 20th of November 1945 until the 1st of October 1946.⁸ The tribunal was made up of judges from the four allied powers, the first being the United States which dealt with conspiracies to commit war crimes. Following this, the British prosecution focused upon the planning, preparations, initiations and waging of aggressive war. The third prosecution dealt with violation of the laws and customs of war as well as crimes against humanity and was conducted in France. Lastly, was the Soviet prosecution which the same counts as in the East.⁸

The medical trial was the first of the prosecutions to take place and exposed the atrocities that were perpetrated in the concentration camps. This included the euthanasia program for people with mental and physical abilities.¹ Consequently, on the 1st of October 1946, twelve of the twenty-two Nazi defendants were sentenced to death, seven to imprisonment ranging from ten years to life, three were acquitted and three of the six accused organisations were found to be criminal by the International Military Tribunal at Nuremberg.⁸ Additionally, only twenty-one defendants were present at the trial as one had committed suicide whist in custody.⁸

Today, the Nuremberg trial is considered the source which promulgated the first international effort to codify ethics of human research; the Nuremberg Code.¹

Whilst the Nazi experiments accentuate the inhumane capabilities of humans, it simultaneously provided an important historical turning point in medicine as it led to the introduction of the Nuremberg code; a set of principles to protect humans from unethical experimentation.² The Nuremberg code consisted of ten principles, however the three main principles were; (i) obtaining informed consent, (ii) experimentation must be based on animal studies regarding the natural history of disease and results must be good of society and unobtainable by other methods, (iii) experimentation must only be conducted by those who are scientifically qualified.²

The Nuremberg Code became the first international code designed to prevent the recurrence of such inhumane acts exhibited during Nazi experimentation.² Today, the Nuremberg Code serves as a blueprint for principles which ensure the rights of participants in medical research.⁶ That said, it is important to note that because of the extreme circumstances in which the Nuremberg Code was created, there has been some deliberation regarding its applicability to modern medicine.⁶

References:

¹Appelbaum, Paul S. “Doctors from Hell: The horrific account of Nazi experiments on Humans” The New England Journal of Medicine 353 no. 11 (2005): 1187-1188.

²Benedict, Susan and Georges, Jane M. “Nurses and the sterilisation experiments of Auschwitz: A postmodernist perspective” Nursing Inquiry 13, no 4 (2006): 277-288.

³Colaianni, Alessandra. “A long shadow: Nazi doctors, moral vulnerability and contemporary medical culture” Journal of Medical Ethics 38 no. 7 (2012): 435-438.

⁴Grodin, Michael and Annas, George. “Physicians and torture: lessons from the Nazi doctors” International Review of the Red Cross 89, no 867 (2007): 635-654.

⁵“Nazi Camps.” United States Holocaust Memorial Museum. Accessed October 9, 2016. https://www.ushmm.org/wlc/en/article.php?ModuleId=10005144

⁶Shuster, Evelyne. “Fifty years later: The significance of the Nuremberg Code” The New England Journal of Medicine (1997) 1463-1440.

⁷Weinberg, Gerhard L. World War II: A Very Short Introduction. Oxford, Oxford University Press, 2014) 33.

⁸Wright, Quincy. “The Law of the Nuremberg Trial” The American Journal of International Law 41 no. 1 (1947): 38-72.