Medical Ethics in the 70 Years after the Nuremberg Code, 1947 to the Present

Abstract

Ethics has been an integral part of medicine since ancient times. However, the atrocities committed as part of Nazi medicine necessitated a novel approach, resulting in a framework of modern bioethical standards. Since World War II, we have witnessed a broad movement towards the introduction of normative regulations for medical research. This trend initially started with the Nuremberg Medical Trials and the "Nuremberg Code" of 1947, followed by the Helsinki Declaration of the World Medical Association of 1964, including later modifications and amendments. Furthermore there are relevant recommendations issued by the organs of the Council of Europe and by the World Health Organisation, the UNESCO Declarations and EU legislation, to name only the most important examples. Since the 1970s, the rapid and global development of the life sciences, with its unprecedented possibilities to interfere with basic aspects of human life, for example in reproductive medicine, has led to an even greater necessity to confront bioethical questions worldwide. The HIV pandemic burdening the Global South has required conducting research in different areas of the world and involving especially vulnerable populations. In view of these developments, the main topic of the conference was the influence of Nazi medical crimes, the Nuremberg Medical Trial and the resulting Nuremberg Code on the development of international bioethical norms, including the enduring impact of this legacy on today's medical research. In the 70 years since the promulgation of the Code, the world has changed: Research is based on the principles of exchange and cooperation, researchers are mobile, the internet provides a supporting framework removing national barriers. Although the European situation, with special attention to Austria, was part of the discussion, an important focus of the conference was on the role played by international organisations and their endeavours to establish normative standards for clinical research with a worldwide reach.

The evolving ethics of anatomy: Dissecting an unethical past in order to prepare for a future of ethical anatomical practice

“…By the end of the 19th century, vivisections of both humans and animals are considered unethical, as was the practice of forcing the donation of bodies under the Anatomy Act, which was not actually repealed/replaced until 1984 (Czech et al, 2018). Eventually, the modern concept of body donation became publically acceptable and the modern era of ethical anatomy practice beginning to emerge (Garment et al, 2007).…”

“…The concept of informed consent was radically violated under the Third Reich because dissections were performed without the consent of the person who was the subject or the persons surrogate decision maker (Hildebrandt, 2006). The principle of informed consent requires that the person or their surrogate must consent to the use of the deceased's body for dissection and must be given information about what will become of their body upon death (Czech et al, 2018). While there is no gold standard for what informed consent should entail in anatomy, it is ethically prudent for informed consent to go beyond simply agreeing to the use of a body for dissection.…”

“…The concept of free and informed consent is one of the most important concepts of modern anatomical practice derived from the Nuremburg Code (Czech et al, 2018). The concept of informed consent was radically violated under the Third Reich because dissections were performed without the consent of the person who was the subject or the persons surrogate decision maker (Hildebrandt, 2006).…”

Books, bones and bodies: The relevance of the history of anatomy in Nazi Germany for medical education today

“…According to the International Federation of the Associations of Anatomists, body donations are considered the best ethical practice for anatomical body procurement, as they take into account questions of informed consent and free will (FICEM, 2012; Jones, 2016). It should be noted that the concept of informed consent in medical research is one of the central tenets laid out in the Nuremberg Code, which is a direct outcome of the Nuremberg Doctors' Trial in 1946/47 (Annas & Grodin, 1992; Czech, Druml, & Weindling, 2018; Schmidt, 2004; Weindling, 2004).…”

Cautions About Medicalized Dehumanization

“…13 The trial served as the impetus for the drafting of the Nuremberg Code, a postwar blueprint of bioethical principles intended to guide human subjects research ethics. 14,15 Although the drafting of the code was a pivotal moment in bioethics' history, its heavy emphasis on ghastly experimentation and euthanasia underplayed "the nonmilitary ideological and occupational motivations" of clinicians and scientists that permeated the discourse on racial hygiene in less dramatic yet insidious ways. 16 Postwar human subjects research.…”