The Nuremberg Code (german: Nürnberger Kodex) is a set of
ethical research principles for
human experimentation created by the court in ''
U.S. v Brandt'', one of the
Subsequent Nuremberg trials that were held after the
Second World War
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposi ...
.
Though it was articulated as part of the court's verdict in the trial, the Code would later become significant beyond its original context; in a review written on the 50th anniversary of the ''Brandt'' verdict,
Jay Katz
Jacob "Jay" Katz (October 20, 1922 – November 17, 2008) was an American physician and Yale Law School professor whose career was devoted to addressing complex issues of medical ethics and other ethical problems involving the overlaps of ethi ...
writes that "a careful reading of the judgment suggests that
he authors
He or HE may refer to:
Language
* He (pronoun), an English pronoun
* He (kana), the romanization of the Japanese kana へ
* He (letter), the fifth letter of many Semitic alphabets
* He (Cyrillic), a letter of the Cyrillic script called ''He'' ...
wrote the Code for the practice of human experimentation whenever it is being conducted."
Background
The origin of the Code began in pre–
World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the World War II by country, vast majority of the world's countries—including all of the great power ...
German politics, particularly during the 1930s and 1940s. Starting in the mid-1920s, German physicians, usually proponents of
racial hygiene
The term racial hygiene was used to describe an approach to eugenics in the early 20th century, which found its most extensive implementation in Nazi Germany (Nazi eugenics). It was marked by efforts to avoid miscegenation, analogous to an animal ...
, were accused by the public and the medical society of
unethical
Ethics or moral philosophy is a branch of philosophy that "involves systematizing, defending, and recommending concepts of right and wrong behavior".''Internet Encyclopedia of Philosophy'' The field of ethics, along with aesthetics, concerns ma ...
medical practices. The use of racial hygiene was supported by the German government in order to promote an
Aryan race
The Aryan race is an obsolete historical race concept that emerged in the late-19th century to describe people of Proto-Indo-European heritage as a racial grouping. The terminology derives from the historical usage of Aryan, used by modern ...
. Racial hygiene extremists merged with
National Socialism
Nazism ( ; german: Nazismus), the common name in English for National Socialism (german: Nationalsozialismus, ), is the far-right totalitarian political ideology and practices associated with Adolf Hitler and the Nazi Party (NSDAP) in Naz ...
to promote the use of biology to accomplish their goals of racial purity, a core concept in the Nationalist ideology. Physicians were attracted to the scientific ideology and aided in the establishment of
National Socialist Physicians' League in 1929 to "purify the German medical community of 'Jewish
Bolshevism
Bolshevism (from Bolshevik) is a revolutionary socialist current of Soviet Marxist–Leninist political thought and political regime associated with the formation of a rigidly centralized, cohesive and disciplined party of social revolution, ...
'." Criticism was becoming prevalent; Alfons Stauder, member of the Reich Health Office, claimed that the "dubious experiments have no therapeutic purpose", and Fredrich von Muller, physician and the president of the
Deutsche Akademie, joined the criticism.
[Grodin MA. "Historical origins of the Nuremberg Code". In: ''The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation''. Annas, GJ and Grodin, MA (eds.). Oxford University Press, Oxford, 1992.]
In response to the criticism of unethical human experimentation, the
Weimar Republic
The Weimar Republic (german: link=no, Weimarer Republik ), officially named the German Reich, was the government of Germany from 1918 to 1933, during which it was a Constitutional republic, constitutional federal republic for the first time in ...
(Germany's government from 1919 to 1933) issued "Guidelines for New Therapy and Human Experimentation". The guidelines were based on
beneficence and
non-maleficence
' () is a Latin phrase that means "first, do no harm". The phrase is sometimes recorded as '.
Non-maleficence, which is derived from the maxim, is one of the principal precepts of bioethics that all students in healthcare are taught in school a ...
, but also stressed legal doctrine of
informed consent
Informed consent is a principle in medical ethics and medical law, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treat ...
. The guidelines clearly distinguished the difference between therapeutic and non-therapeutic research. For therapeutic purposes, the guidelines allowed administration without consent only in dire situations, but for non-therapeutic purposes any administration without consent was strictly forbidden. However, the guidelines from Weimar were negated by
Adolf Hitler
Adolf Hitler (; 20 April 188930 April 1945) was an Austrian-born German politician who was dictator of Germany from 1933 until his death in 1945. He rose to power as the leader of the Nazi Party, becoming the chancellor in 1933 and the ...
. By 1942, the Nazi party included more than 38,000 German physicians, who helped carry out medical programs such as
the Sterilization Law.
After World War II, a series of trials were held to hold members of the Nazi party responsible for a multitude of
war crimes. The trials were approved by President
Harry Truman
Harry S. Truman (May 8, 1884December 26, 1972) was the 33rd president of the United States, serving from 1945 to 1953. A leader of the Democratic Party, he previously served as the 34th vice president from January to April 1945 under Franklin ...
on 2 May 1945, and were led by the United States, Great Britain, and the Soviet Union. They began on 20 November 1945, in
Nuremberg
Nuremberg ( ; german: link=no, Nürnberg ; in the local East Franconian dialect: ''Nämberch'' ) is the second-largest city of the German state of Bavaria after its capital Munich, and its 518,370 (2019) inhabitants make it the 14th-largest ...
, Germany, in what became known as the
Nuremberg trials
The Nuremberg trials were held by the Allies of World War II, Allies against representatives of the defeated Nazi Germany, for plotting and carrying out invasions of other countries, and other crimes, in World War II.
Between 1939 and 1945 ...
. In the trial of ''USA v. Brandt,'' which became known as the "
Doctors' Trial
The Doctors' Trial (officially ''United States of America v. Karl Brandt, et al.'') was the first of 12 trials for war crimes of high-ranking German officials and industrialists that the United States authorities held in their occupation zone ...
", German physicians responsible for conducting unethical medical procedures on humans during the war were tried. They focused on physicians who conducted inhumane and unethical human experiments in
concentration camps, in addition to those who were involved in over 3.5 million
sterilization
Sterilization may refer to:
* Sterilization (microbiology), killing or inactivation of micro-organisms
* Soil steam sterilization, a farming technique that sterilizes soil with steam in open fields or greenhouses
* Sterilization (medicine) rende ...
s of German citizens.
Several of the accused argued that their experiments differed little from those used before the war, and that there was no law that differentiated between legal and illegal experiments. This worried Drs. Andrew Ivy and Leo Alexander, who worked with the prosecution during the trial. In April 1947, Dr. Alexander submitted a memorandum to the
United States Counsel for War Crimes outlining six points for legitimate medical research.
An early version of the Code known as the Memorandum, which stated explicit voluntary consent from patients are required for human experimentation, was drafted on 9 August 1947.
On 20 August 1947, the judges delivered their verdict against
Karl Brandt and 22 others.
[Annas, George J., and Michael A. Grodin. ''The Nazi Doctors and the Nuremberg Code''. New York: Oxford University Press, 1992.] The verdict reiterated the Memorandum's points and, in response to expert medical advisers for the prosecution, revised the original six points of the Memorandum to ten points. The ten points became known as the Code, which includes such principles as
informed consent
Informed consent is a principle in medical ethics and medical law, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treat ...
and absence of
coercion
Coercion () is compelling a party to act in an involuntary manner by the use of threats, including threats to use force against a party. It involves a set of forceful actions which violate the free will of an individual in order to induce a des ...
; properly formulated
scientific
Science is a systematic endeavor that builds and organizes knowledge in the form of testable explanations and predictions about the universe.
Science may be as old as the human species, and some of the earliest archeological evidence for ...
experimentation; and
beneficence towards experiment participants. It is thought to have been mainly based on the
Hippocratic Oath
The Hippocratic Oath is an oath of ethics historically taken by physicians. It is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear, by a number of healing gods, to uphold specific e ...
, which was interpreted as endorsing the experimental approach to medicine while protecting the patient.
Authorship 'controversy'
The Code was initially ignored, but gained much greater significance about 20 years after it was written. As a result, there were substantial rival claims for the creation of the Code. Some claimed that
Harold Sebring
Harold Leon Sebring (March 9, 1898 – July 26, 1968), nicknamed Tom Sebring, was a Florida Supreme Court justice, and an American judge at one of the Subsequent Nuremberg Trials of German war criminals after World War II. Sebring was a native ...
, one of the three U.S. judges who presided over the
Doctors' trial
The Doctors' Trial (officially ''United States of America v. Karl Brandt, et al.'') was the first of 12 trials for war crimes of high-ranking German officials and industrialists that the United States authorities held in their occupation zone ...
, was the author.
Leo Alexander
Leo Alexander (October 11, 1905 – July 20, 1985) was an American psychiatrist, neurologist, educator, and author, of Austrian-Jewish origin. He was a key medical advisor during the Nuremberg Trials. Alexander wrote part of the Nuremberg Code, ...
, MD and
Andrew Ivy, MD, the prosecution's chief medical expert witnesses, were also each identified as authors. In his letter to
Maurice Henry Pappworth
Maurice Henry Pappworth (9 January 1910 – 12 October 1994) was a pioneering British medical ethicist and tutor, best known for his 1967 book ''Human Guinea Pigs'', which exposed the unethical dimensions of medical research. Born and educated in ...
, an English physician and the author of the 1967 book ''
Human Guinea Pigs'', Andrew Ivy claimed sole authorship of the code. Leo Alexander, approximately 30 years after the trial, also claimed sole authorship.
However, after careful reading of the transcript of the Doctors' trial, background documents, and the final judgements, it is more accepted that the authorship was shared and the code grew out of the trial itself.
The ten points of the Nuremberg Code
The ten points of the code were given in the section of the judges'
verdict
In law, a verdict is the formal finding of fact made by a jury on matters or questions submitted to the jury by a judge. In a bench trial, the judge's decision near the end of the trial is simply referred to as a finding. In England and Wales ...
entitled "Permissible Medical Experiments":
[
]
Importance
The Code has not been officially accepted as law by any nation or as official ethics guidelines by any association. In fact, the Code's reference to Hippocratic duty to the individual patient and the need to provide information was not initially favored by the American Medical Association
The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016.
The AMA's sta ...
. Katz observes that the Western world initially dismissed the Nuremberg Code as a "code for barbarians, but unnecessary (or superfluous) for ordinary physicians." Additionally, the final judgment did not specify whether the Code should be applied to cases such as political prisoner
A political prisoner is someone imprisoned for their political activity. The political offense is not always the official reason for the prisoner's detention.
There is no internationally recognized legal definition of the concept, although nu ...
s, convicted felons, and healthy volunteers. The lack of clarity, the brutality of the unethical medical experiments, and the uncompromising language of the Code created an image that it was designed for singularly egregious transgressions.
However, the Code is considered by some to be the most important document in the history of clinical research ethics Clinical research ethics are the set of relevant ethics considered in the conduct of a clinical trial in the field of clinical research. It borrows from the broader fields of research ethics and medical ethics.
Governance
Most directly a local ins ...
, because of its massive influence on global human rights. In the United States, the Code and the related Declaration of Helsinki
The Declaration of Helsinki (DoH, fi, Helsingin julistus, sv, Helsingforsdeklarationen) is a set of ethical principles regarding human experimentation developed originally in 1964 for the medical community by the World Medical Association (WMA ...
influenced the drafting of regulations promulgated by the United States Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
to ensure ethical treatment of human research subjects, known as the Common Rule
The Common Rule is a 1981 rule of ethics in the United States regarding biomedical and behavioral research involving human subjects. A significant revision became effective July 2018. It governed Institutional Review Boards for oversight of huma ...
, which is now codified in Part 46 of Title 45 of the Code of Federal Regulations
In the law of the United States, the ''Code of Federal Regulations'' (''CFR'') is the codification of the general and permanent regulations promulgated by the executive departments and agencies of the federal government of the United States. ...
. These regulations are enforced by Institutional Review Boards
An institutional review board (IRB), also known as an independent ethics committee (IEC), ethical review board (ERB), or research ethics board (REB), is a committee that applies research ethics by reviewing the methods proposed for research to en ...
(IRBs). In 1966, the International Covenant on Civil and Political Rights
The International Covenant on Civil and Political Rights (ICCPR) is a multilateral treaty that commits nations to respect the civil and political rights of individuals, including the right to life, freedom of religion, freedom of speech, fre ...
was adopted by the United Nations
The United Nations (UN) is an intergovernmental organization whose stated purposes are to maintain international peace and security, develop friendly relations among nations, achieve international cooperation, and be a centre for harmoni ...
, and after enough nations had ratified the Covenant, it came into force on 23 March 1976. Article Seven prohibits experiments conducted without the " free consent to medical or scientific experimentation" of the subject.[ As of September 2019, the Covenant has 173 states parties.
In his 2014 review, Gaw observes that the Code "not only entered the legal landscape, but also became the prototype for all future codes of ethical practice across the globe."][ The idea of free or ]informed consent
Informed consent is a principle in medical ethics and medical law, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treat ...
also served as the basis for International Ethical Guidelines for Biomedical Research Involving Human Subjects proposed by the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
.[ Another notable symposium review was published by the ]Medical University of Vienna
The Medical University of Vienna (German: ''Medizinische Universität Wien'') is a public university located in Vienna, Austria. It is the direct successor to the faculty of medicine at the University of Vienna, founded in 1365 by Rudolf IV, Du ...
in 2017: "Medical Ethics in the 70 Years after the Nuremberg Code, 1947 to the Present". President and Rector Markus Muller writes in his introduction that the Code "constitutes one of the most important milestones in the history of medicine, providing for the first time a proper framework for research on human subjects. This milestone was not a voluntary, precautionary measure, but only came into existence in the aftermath of Nazi atrocities. The Nuremberg Code became a cornerstone of clinical research and bioethics."
In 1995, Judge Sandra Beckwith ruled in the case ''In Re Cincinnati Radiation Litigation'' (874 F. Supp 1995) that the Nuremberg Code may be applied in criminal and civil litigation in the Federal Courts of the United States.
See also
References
Further reading
*Weindling, Paul: ''Nazi Medicine and the Nuremberg Trials'' (Palgrave, Basingstoke 2004)
*Schmidt, Ulf: ''Justice at Nuremberg: Leo Alexander and the Nazi Doctors' Trial'' (Palgrave, Basingstoke 2004)
*Schmidt, Ulf: Karl Brandt. ''The Nazi Doctor: Medicine and Power in the Third Reich'' (Continuum, London, 2007)
*
*
*''BRITISH MEDICAL JOURNAL'' No. 7070, Volume 313: page 1448, 7 December 1996.
*"The Nuremberg Code" (1947). In: Mitscherlich A, Mielke F. '' Doctors of Infamy: The Story of the Nazi Medical Crimes''. New York: Schuman, 1949: xxiii–xxv.
*Carl Elliot's articl
"Making a Killing"
in ''Mother Jones'' magazine (September 2010) asks if the Nuremberg Code is a valid legal precedent in Minnesota
External links
The Nuremberg Code (1947)
on the BRITISH MEDICAL JOURNAL
Nuremberg Code
at the United States Holocaust Memorial Museum
{{Research participant rights
The Holocaust
International criminal law
Human subject research
Design of experiments
1947 in law
United States Nuremberg Military Tribunals
Ethics and statistics
1947 in science
Research ethics
code
In communications and information processing, code is a system of rules to convert information—such as a letter, word, sound, image, or gesture—into another form, sometimes shortened or secret, for communication through a communicati ...
1940s in Bavaria
1947 in Germany
1947 documents