The Nuremberg Code (Permissible Medical Experiments)

Summary

The Nuremberg Code is a list of ten principles for research on human beings. It forms a short section, titled 'Permissible Medical Experiments', of the judgment handed down in August 1947 in the trial known as the Doctors' Trial, the first of the twelve trials held by American military tribunals at Nuremberg after the main trial of Nazi leaders. Twenty-three defendants, most of them physicians, were accused of war crimes and crimes against humanity for experiments carried out without consent on prisoners in concentration camps. Prisoners had been frozen in icy water, exposed to the conditions of high altitude in pressure chambers, deliberately infected with malaria, typhus and other diseases, wounded and infected to test drugs, and sterilized. Many died or were permanently injured. The defendants argued that research on humans was practised elsewhere and that there were no clear international rules. In reply the judges set out the principles they believed all civilized medical research must observe. The first and longest principle states that the voluntary consent of the human subject is absolutely essential. The person must be legally able to consent, free from force, fraud or coercion, and must understand the nature, purpose and risks of the experiment; the duty to obtain consent belongs personally to each researcher. The remaining nine principles require that experiments aim at results useful to society and unobtainable by other means; that they be based on animal studies and knowledge of the disease; that they avoid unnecessary suffering; that none be done where death or disabling injury is expected; that risk never exceed the humanitarian importance of the problem; that subjects be protected; that only qualified scientists conduct them; that the subject may stop at any time; and that the scientist must stop if continuing is likely to cause injury or death. Sixteen defendants were convicted and seven were executed in 1948. The Code influenced the Declaration of Helsinki (1964), the Belmont Report (1979) and research ethics worldwide.

Plot or Argument

• Context

  The judges explain that some medical experiments on humans are ethical if kept within well-defined bounds, and that basic principles must be observed.

• Principle 1: consent

  Voluntary, informed consent of the subject is absolutely essential, and responsibility for it is personal.

• Principles 2–3: purpose and design

  Experiments must aim at useful results unobtainable otherwise and be based on prior animal research.

• Principles 4–7: protection

  Avoid unnecessary suffering; no experiment where death or disabling injury is expected; risk proportioned to importance; adequate protections.

• Principles 8–10: conduct and stopping

  Only qualified scientists may conduct experiments; the subject may withdraw; the scientist must stop if harm is likely.

Lessons

• Consent and dignity

  The Code begins with consent because the crimes it answered treated prisoners as material rather than persons. Respecting a person means letting him decide what is done to his body.

  • What four elements of consent does the first principle require?
  • Why does the Code say the duty to obtain consent cannot be delegated?

• Science under law

  The Doctors' Trial showed that scientific skill without moral limits can serve terrible ends. The Code places research under ethical rules.

  • What arguments did the defendants make, and how does the Code answer them?
  • Why might a scientist be tempted to ignore ethical limits?

• Limits on risk

  Principles 5 and 6 limit how much risk any experiment may impose, no matter how important the question.

  • When, according to the Code, should an experiment never be done?
  • Who decides whether a problem is important enough to justify risk?

• For the Christian reader

  Christian teaching holds that every human being bears the image of God and may never be used merely as a means. The Code puts into legal form the conviction that the weak and imprisoned must be protected, not exploited.

  • How does the doctrine of the image of God support the first principle?
  • How should Christians in science and medicine respond to the history behind the Code?

Context

After the International Military Tribunal tried the major Nazi leaders in 1945–1946, the United States held twelve further trials at Nuremberg. The first, Case 1, tried physicians and officials for medical experiments and for the killing of disabled people.

Composition

The trial ran from December 1946 to August 1947. The judges included the ten principles in their judgment, drawing on memoranda by the medical consultants Andrew Ivy and Leo Alexander. The text was printed in Trials of War Criminals before the Nuernberg Military Tribunals, volume 2 (1949).

Reception

The Code was little cited at first, but after revelations of unethical research in the 1960s and 1970s it became a foundation of research ethics, informing the Declaration of Helsinki and American federal rules.

Comparisons

• The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research

  The Belmont Report develops the Code's principles into a framework for American research regulation.

• Opening Statement at the Nuremberg Trial

  Jackson's opening at the main Nuremberg trial explains why the Allies chose law over vengeance.

• Hippocratic Writings

  The Hippocratic Oath's promise to do no harm is the older root of the Code's limits.

• Buck v. Bell

  The 1927 Supreme Court decision upholding forced sterilization shows that abuses were not confined to Germany.

Quotes

For Students

A reading companion for classical Christian high school students. See the student guide.

Reading Guide

Watch for

• The reasons the judges give before the list.
• Every requirement of consent in principle 1.
• Limits on risk in principles 5 and 6.
• The rights of the subject and duties of the scientist at the end.

Key terms and names

Informed consent

Agreement to take part given freely by someone who understands the purpose, method and risks.

Coercion

Pressure or force that takes away free choice.

Crimes against humanity

Grave crimes such as murder and enslavement committed against civilians on a large scale.

Military tribunal

A court set up by military authority, here by the United States in occupied Germany.

Seminar Questions

1. Comprehension What is the first principle of the Code?
2. Comprehension Under what conditions may a subject end an experiment?
3. Interpretation Why did the judges think a written list of principles was needed?
4. Interpretation How do principles 5 and 6 balance knowledge against risk?
5. Interpretation Why does the Code place voluntary consent first, before any other principle?
6. Big Question Can any scientific goal justify harming an unwilling person?

Faith Connections

• Genesis 1:27 (Scripture)

  Humans are made in the image of God, the root of the conviction that no person may be used as a mere object.

• Proverbs 31:8–9 (Scripture)

  "Open thy mouth for the dumb": defending those who cannot defend themselves.

• Kant, Groundwork of the Metaphysics of Morals (Great Conversation)

  Treat humanity always as an end, never merely as a means.

Logic and Rhetoric

Central argument: Human experimentation can be ethical only within strict limits, the first and most important of which is the voluntary, informed consent of the subject.

Rhetorical device: enumeration. The judges set out ten numbered principles, moving from consent to purpose, design, risk and the right to stop.

Debate: Resolved: that no medical experiment may ever be conducted without the subject's informed consent.

Memory Work

The voluntary consent of the human subject is absolutely essential.

Writing Prompts

Essay: Explain how the Nuremberg Code responds to the crimes of the Nazi doctors.

Comparison with The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research: Compare the Nuremberg Code's list of rules with the Belmont Report's three principles.

Medical Lens

The foundational statement of research ethics, written in response to Nazi medical crimes.

• Principle 1

  Informed, voluntary consent.

  Medical Ethics
• Principles 5–10

  Limits on risk and the right to stop.

  Medical Ethics

Creative Prompts

• Essay

  Explain why consent comes first in the Nuremberg Code and what it requires.

• Classroom

  Rewrite the ten principles in plain modern English and compare your version with the original.

• Dialogue

  Write a conversation between a researcher and a volunteer in which each principle is respected.

Further Reading

• The Nazi Doctors and the Nuremberg Code, George J. Annas and Michael A. Grodin (eds.)