Editorials

Nuremberg code turns 60 Michel Thieren a & Alexandre Mauron b

This month marks sixty years since advances do not prevail over the health legal doctrine protecting individuals the Nuremberg code1 – the basic and safety of individuals without their against harm induced by scientific text of modern medical ethics – was fully informed consent in medical practices at large, including not only issued. The principles in this code experiments. However, we ask whether human beings as subjects of medical were articulated in the context of modern ethics and its binding instru- experiments but also as consumers and the Nuremberg trials in 1947. We ments can always secure full protection beneficiaries of science’s outcomes. O would like to use this anniversary to experimental subjects and beyond to examine its ability to address the them, to the recipients of health care. In References ethical challenges of our time. One a context of relentless competition for 1. Permissible Medical Experiments. Trials of of these is the question of scientific resources among scientific institutions, War Criminals before the Nuremberg Military misconduct downstream to medical ethical vigilance is a permanent neces- Tribunals under Control Council Law No. research, particularly when biased sity. Falsification of scientific results 10: Nuremberg October 1946–April 1949. Washington: U.S. Government Printing Office interpretations of clinical studies and the premature release of drugs on (n.d.), vol. 2, pp. 181-182. lead to an overoptimistic assessment the market show that modern ethics 2. Cahana A., Mauron A. The story of Vioxx of a new drug, which ends up does not in itself provide full protection – no pain and a lot of gain: ethical concerns being withdrawn from the market against scientific misconduct, especially regarding conduct of the pharmaceutical after harming many individuals, when it occurs beyond the critical step industry. J Anesth 2006;20:348-351. as happened with rofecoxib.2 A of malevolent or unsafe experiments 3. Alexander L. Medical science under dictatorship. second development is one that the involving human beings. NEJM 1949;40:241. 4. Roelcke V, Maio G (ed.): Twentieth Century Nuremberg judges could hardly have Bioethics experts Paul Weindling Ethics of Human Subjects Research. Historical foreseen. In the age of AIDS, human and Volker Roelcke suggest that cur- Perspectives on Values, Practices, and research ethics began to be invoked rent bioethical thinking may use an Regulations, p.162, Stuttgart, Franz Steiner not only to offer protection from incomplete picture of the historical Verlag, 2004. research, but also to gain access to context of the Nuremberg code. Volker it. The AIDS crisis turned the fact Roelcke writes: “rather than being the of becoming a research subject into result of a coercive state, Nazi medicine a kind of privilege, as it carried the illustrates how medical researchers and hope of early access to treatment. their representative bodies […] co-op- Ethics must now reconcile two erated with and even manipulated a antagonistic objectives: protecting totalitarian state and political system research subjects from possible harm, relying on expert opinion, in order to while ensuring non-discriminatory gain resources for the conduct of research access to research for potential without any moral and legal regulation.” subjects; a tough balancing act. He states that Nazi doctors “followed The Nuremberg code evokes a the intrinsic logic of their scientific dark time for medicine, yet remains a disciplines and used the legally and ethi- powerful symbol in inspiring the medi- cally unrestricted access to human beings cal profession to stand up for its Hip- created by the context of the political pocratic values and protect individuals system and the conditions of war.”4 By from harmful medical experiments. centring exclusively on the war crimes For the past 60 years, a series of and not on their broader context, the ethical texts and instruments have re- judges at Nuremberg issued the code layed the Nuremberg court’s opinion,3 in order solely to set the boundaries and completed or interpreted the code for “permissible experiments” and tackle in the multifaceted context of medical the difficult question of the biomedical experimentation. The medical profes- research conducted on human subjects sion thus draws on a vast body of ethi- outside Germany during the war. The cal reflection to ensure that scientific court thus failed to produce a broader

a Information, Evidence and Research Cluster; Member of the WHO Ethics Review Committee. World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland. Correspondence to Michel Thieren (e-mail: [email protected]). b Institut d’éthique biomédicale, Centre médical universitaire, Université de Genève, Switzerland. doi: 10.2471/BLT.07.045443

Bulletin of the World Health Organization | August 2007, 85 (8) 573