MEDICAL ETHICS
From left: Nazi doctors on trial for ‘scientific death’ experiments on prisoners; Leo Alexander points out injuries sustained by a Polish inmate of one of the concentration camps; the Nuremberg Palace of Justice – where the trials took place
this true? Although largely ignored for around two decades, by the mid-1960s a number of important events had occurred that refocused professional and public attention on the issues. Tese included the publication of the Declaration of Helsinki in 1964, and catalogues of unethical human research in the post-war period compiled by the American anaesthetist Henry Beecher in 1966, and the English physician Maurice Pappworth in 1967. Collectively, these events pushed forward the need for change and tighter control of medical research. Te rapidly changing social and cultural
backdrop of the 1960s may also have significantly contributed to this development. Every idea has its time, and in the late 1940s the medical profession was not ready to address the ethical issues central to the Code. By the 1960s, it was. But what would the research ethics
landscape look like today if there had been no Nuremberg Code? Counterfactuals are always problematic, but this one allows us to consider the true historical importance of the Code. As the document was largely ignored aſter its publication it is difficult to claim that it prevented many unethical experiments from being conducted in the
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1940s and the 1950s. Indeed, the scale of the unethical practices Beecher and Pappworth exposed would support the notion that the Code had no impact at all. Without the Code, however, these whistle-blowers would have had no moral yardstick. Te Nuremberg Code, like all codes of practice, set a standard. Whether that standard is followed is another matter, but its very existence provides a profession, and the observers of that profession, with the means to distinguish right from wrong. Such a code, however, already existed
for the medical profession in the form of the Hippocratic Oath. What did the Nuremberg Code add to this, if anything? Both place our patients at the centre of our work, along with an over-riding requirement for beneficence and non- maleficence. Te Code, however, is primarily concerned with research rather than practice and emphasises the importance and need for informed consent in that setting. Tis importance may be implicit in the Oath, but only the Code insists that it is the foundation stone of all human research.
Ethical touchstone Te Code began life as a relatively minor
component of a tribunal judgment; what it then became was a touchstone for the development of modern research ethics, acquiring a significance that transcended any issue of individual authorship. Te Code was almost certainly a joint effort involving Alexander, Ivy and the judges, and collectively their legacy is an important one. Te authors of the Nuremberg Code set
in train a movement that has slowly but inexorably led us to the present day matrix of research ethical codes in which we work. It seems unthinkable today that the medical atrocities perpetrated in the Nazi concentrations camps could happen again, but what the authors of the Code still ask us to do is to contemplate that very possibility. Having robust codes of ethics coupled with legally binding regulations derived from the Nuremberg Code helps to ensure that the past will not be repeated.
n Dr Allan Gaw is a writer and educator from Glasgow
Sources • Trials of War Criminals. Washington, DC: Government Printing Office, 1949. • Shuster E. N Engl J Med 1997;13:1436-40. • Schmidt U. Justice at Nuremberg. Palgrave Macmillan, 2006. • Gaw A. JRSM 2014; 107:138-43.
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