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

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wiener klinische wochenschrift The Central European Journal of Medicine 130. Jahrgang 2018, Supplement 3 Wien Klin Wochenschr (2018) 130 :S159–S253 https://​doi.org/​10.1007/​s00508-​018-​1343-y Online publiziert: 8 June 2018 © The Author(s) 2018 Medical Ethics in the 70 Years after the Nuremberg Code, 1947 to the Present International Conference at the Medical University of Vienna, 2nd and 3rd March 2017 Editors: Herwig Czech, Christiane Druml, Paul Weindling With contributions from: Markus Müller, Paul Weindling, Herwig Czech, Aleksandra Loewenau, Miriam Offer, Arianne M. Lachapelle-Henry, Priyanka D. Jethwani, Michael Grodin, Volker Roelcke, Rakefet Zalashik, William E. Seidelman, Edith Raim, Gerrit Hohendorf, Christian Bonah, Florian Schmaltz, Kamila Uzarczyk, Etienne Lepicard, Elmar Doppelfeld, Stefano Semplici, Christiane Druml, Claire Whitaker, Michelle Singh, Nuraan Fakier, Michelle Nderu, Michael Makanga, Renzong Qiu, Sabine Hildebrandt, Andrew Weinstein, Rabbi Joseph A. Polak history of medicine Table of contents Editorial: Medical ethics in the 70 years after the Nuremberg Code, 1947 to the present S161 Markus Müller Post-war prosecutions of ‘medical war crimes’ S162 Paul Weindling: From the Nuremberg “Doctors Trial” to the “Nuremberg Code” S165 Herwig Czech: Post-war trials against perpetrators of Nazi medical crimes – the Austrian case S169 Aleksandra Loewenau: The failure of the West German judicial system in serving justice: the case of Dr. Horst Schumann Miriam Offer: Jewish medical ethics during the Holocaust: the unwritten ethical code From prosecutions to medical ethics S172 Arianne M. Lachapelle-Henry, Priyanka D. Jethwani, Michael Grodin: The complicated legacy of the Nuremberg Code in the United States S180 Volker Roelcke: Medical ethics in Post-War Germany: reconsidering some basic assumptions S183 Rakefet Zalashik: The shadow of the Holocaust and the emergence of bioethics in Israel S186 William E. Seidelman: The tainted eponym: transgression and memory in medical science S191 Edith Raim: West and East German “euthanasia” trials since 1945 The national impacts of the Nuremberg Code S195 Gerrit Hohendorf: The Sewering Affair S199 Christian Bonah/Florian Schmaltz: The reception of the Nuremberg Code and its impact on medical ethics in France: 1947–1954 S202 Kamila Uzarczyk: Auschwitz doctors on trial: the cases of Hans Münch, Johann Paul Kremer and Roman Zenkteller S206 Etienne Lepicard: Nazi medical crimes and the Jerusalem Declaration on Medical Ethics, 1952 From ethics codes to bioethics: international initiatives to codify bioethics S212 Elmar Doppelfeld: The role of the Council of Europe S215 Stefano Semplici: Consent and special vulnerability: the Universal Declaration on Bioethics and Human Rights Bioethics and human rights: the global situation S219 Christiane Druml: Bioethics in Austria and its European context S222 Michael Makanga: The development of bioethics in Africa: the role of the European and Developing Countries Clinical Tri- als Partnership S225 Renzong Qiu: The legacy of the Nuremberg Code and the approach to bioethics in Mainland China To use or not to use S228 Sabine Hildebrandt, William E. Seidelman: To use or not to use: the legitimacy of using unethically obtained scientific results or human tissues from the National Socialist era Contemporary artists on medical ethics from the Nuremberg Medical Trial to the present S231 Andrew Weinstein: Beyond argument: contemporary artists on euthanasia Annex S239 Rabbi Joseph A. Polak: Vienna Protocol for when Jewish or Possibly-Jewish Human Remains are Discovered S160 Medical Ethics in the 70 Years after the Nuremberg Code, 1947 to the Present 1 3 history of medicine Keywords: Bioethics · History · Research ethics · Medi- Editorial: Medical ethics in the 70 years after the cal ethics · Human rights · Transitional justice · Informed Nuremberg Code, 1947 to the present consent · Nuremberg Medical Trial · Nazi medicine · Nuremberg Code · Euthanasia · Moral dilemmas · Geno- Markus Müller, President ( “Rector”) of the Medical cide · Human experimentation · Medical eponyms · Na- University of Vienna tional Socialism · War crimes trials · human experimen- [email protected] tation · human tissues In March 2017, our university commemorated the 70th Summary Ethics has been an integral part of medicine anniversary of the implementation of the Nuremberg since ancient times. However, the atrocities committed Code with the international symposium “Medical ethics as part of Nazi medicine necessitated a novel approach, in the 70 years after the Nuremberg Code, 1947 to the pre­ resulting in a framework of modern bioethical standards. sent”. The Nuremberg Code constitutes one of the most Since World War II, we have witnessed a broad move- important milestones in the history of medicine, provid- ment towards the introduction of normative regulations ing for the first time a proper framework for research on for medical research. This trend initially started with the human subjects. Sadly, this milestone was not a volun- Nuremberg Medical Trials and the “Nuremberg Code” of tary, precautionary measure resulting from enlightened 1947, followed by the Helsinki Declaration of the World humanity, it only came into existence in the aftermath Medical Association of 1964, including later modifica- of dreadful Nazi atrocities. Following its conception, the tions and amendments. Furthermore there are relevant Nuremberg Code bore rich fruit in multiple legal regards, recommendations issued by the organs of the Coun- becoming a cornerstone of clinical research and bioeth- cil of Europe and by the World Health Organisation, the ics [1]. UNESCO Declarations and EU legislation, to name only For Austrian science in particular, the discourse on the most important examples. Since the 1970s, the rapid Nazi crimes and, thus, the Nuremberg Code became a and global development of the life sciences, with its un- special warning from history due to the involvement of precedented possibilities to interfere with basic aspects prominent Austrian physicians in Nazi experiments [2]. of human life, for example in reproductive medicine, has Hitler’s alleged statement to Max Planck “If the dismiss­ led to an even greater necessity to confront bioethical al of Jewish citizens means the annihilation of German questions worldwide. The HIV pandemic burdening the science, then we shall do without science for a few years” Global South has required conducting research in differ- [3], proved to be self-fulfilling in two aspects: firstly, in a ent areas of the world and involving especially vulnera- profound moral way, and secondly a long-lasting intel- ble populations. In view of these developments, the main lectual breakdown in the Austrian scientific communi- topic of the conference was the influence of Nazi medical ty. The importance of the context of the Nuremberg Code crimes, the Nuremberg Medical Trial and the resulting cannot be overestimated and acts as a foundation for the Nuremberg Code on the development of international very basis of the attitudes of a global medical profession, bioethical norms, including the enduring impact of this which today—in a world heavily focused on professional legacy on today’s medical research. In the 70 years since skills and practices—might sometimes be at risk of slip- the promulgation of the Code, the world has changed: ping out of focus. Research is based on the principles of exchange and co- In my inauguration speech as the newly elected rector, operation, researchers are mobile, the internet provides I drew attention to the fact that I consider the transfer of a supporting framework removing national barriers. Al- attitudes to the next generation to be more important for though the European situation, with special attention to a university than the transfer of mere technical skills [4]. Austria, was part of the discussion, an important focus of This idea is also exemplified by the Einstein quote “It’s the conference was on the role played by international or- not intellect that makes a great scientist, it is character”. ganisations and their endeavours to establish normative Unfortunately, this very thinking disappeared in Austria standards for clinical research with a worldwide reach. with the annexation to Nazi Germany. It is to the particu- lar credit of my predecessor, Wolfgang Schütz, and oth- ers of his generation like Wilfred Druml, former editor of the “Wiener Klinische Wochenschrift”—the once high- ly prestigious journal where Karl Landsteiner described his discovery of blood groups—that our university has fo- cused on the dreadful time of 1938–1945 once more [5, 6]. In particular, the distressing fact was acknowledged that “little was done after the war, following the collapse of the Third Reich, to correct the flagrant injustice and barba­ Dr. Christiane Druml () rism” [5] and that many were allowed to continue their UNESCO Chair on Bioethics of the Medical University of Vienna Ethics, Collections and History of Medicine of the work, like Eduard Pernkopf, a former rector of the uni- Medical University of Vienna versity, who continued work on his notorious anatomi- 1090 Vienna, Austria cal atlas [7, 8]. The question on how to deal with human [email protected] remains was also a focus of the symposium, as reflected 1 3 Medical Ethics in the 70 Years after the Nuremberg Code, 1947 to the Present S161 history of medicine by Rabbi J. Polak’s “Vienna Protocol for when Jewish or atrocities in the future [13]. There
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