The Nuremberg Code () is a set of
ethical research principles for
human experimentation
Human subject research is systematic, scientific investigation that can be either interventional (a "trial") or observational (no "test article") and involves human beings as research subjects, commonly known as test subjects. Human subject r ...
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 (1 September 1939 – 2 September 1945) was a World war, global conflict between two coalitions: the Allies of World War II, Allies and the Axis powers. World War II by country, Nearly all of the wo ...
.
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 writes that "a careful reading of the judgment suggests that
he authorswrote 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 (1 September 1939 – 2 September 1945) was a World war, global conflict between two coalitions: the Allies of World War II, Allies and the Axis powers. World War II by country, Nearly all of the wo ...
German politics, particularly during the 1930s and 1940s. Starting in the mid-1920s, German physicians, usually proponents of
racial hygiene, were accused by the public and the medical society of
unethical
Ethics is the philosophical study of moral phenomena. Also called moral philosophy, it investigates normative questions about what people ought to do or which behavior is morally right. Its main branches include normative ethics, applied eth ...
medical practices. The use of racial hygiene was supported by the German government in order to promote an
Aryan race
The Aryan race is a pseudoscientific historical race concepts, historical race concept that emerged in the late-19th century to describe people who descend from the Proto-Indo-Europeans as a Race (human categorization), racial grouping. The ter ...
. Racial hygiene extremists merged with
National Socialism
Nazism (), formally named National Socialism (NS; , ), is the far-right totalitarian socio-political ideology and practices associated with Adolf Hitler and the Nazi Party (NSDAP) in Germany. During Hitler's rise to power, it was frequ ...
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 the National Socialist Physicians' League in 1929 to "purify the German medical community of '
Jewish Bolshevism'." 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
The Academy for the Scholarly Research and Fostering of Germandom (''die Akademie zur Wissenschaftlichen Erforschung und Pflege des Deutschtums''), or German Academy (''die Deutsche Akademie'', ), was a German cultural institute founded in 1925 at ...
, 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, officially known as the German Reich, was the German Reich, German state from 1918 to 1933, during which it was a constitutional republic for the first time in history; hence it is also referred to, and unofficially proclai ...
(Germany's government from 1919 to 1933) issued "Guidelines for New Therapy and Human Experimentation". The guidelines were based on
beneficence and
non-maleficence, but also stressed the legal doctrine of
informed consent
Informed consent is an applied ethics principle that a person must have sufficient information and understanding before making decisions about accepting risk. Pertinent information may include risks and benefits of treatments, alternative treatme ...
. 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 1889 – 30 April 1945) was an Austrian-born German politician who was the dictator of Nazi Germany from 1933 until Death of Adolf Hitler, his suicide in 1945. Adolf Hitler's rise to power, He rose to power as the lea ...
. 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 crime
A war crime is a violation of the laws of war that gives rise to individual criminal responsibility for actions by combatants in action, such as intentionally killing civilians or intentionally killing prisoners of war, torture, taking hostage ...
s. 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. As the 34th vice president in 1945, he assumed the presidency upon the death of Franklin D. Roosevelt that year. Subsequen ...
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 (, ; ; in the local East Franconian dialect: ''Nämberch'' ) is the Franconia#Towns and cities, largest city in Franconia, the List of cities in Bavaria by population, second-largest city in the States of Germany, German state of Bav ...
, Germany, in what became known as the
Nuremberg trials #REDIRECT Nuremberg trials
{{redirect category shell, {{R from other capitalisation{{R from move ...
. In the trial of ''USA v. Brandt,'' which became known as the "
Doctors' Trial", 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
A concentration camp is a prison or other facility used for the internment of political prisoners or politically targeted demographics, such as members of national or ethnic minority groups, on the grounds of national security, or for exploit ...
, in addition to those who were involved in over 3.5 million
sterilizations 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
Andrew Ivy and
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, ...
, who worked with the prosecution during the trial. In April 1947, 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 is 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 an applied ethics principle that a person must have sufficient information and understanding before making decisions about accepting risk. Pertinent information may include risks and benefits of treatments, alternative treatme ...
and absence of
coercion
Coercion involves compelling a party to act in an involuntary manner through the use of threats, including threats to use force against that party. It involves a set of forceful actions which violate the free will of an individual in order to i ...
; properly formulated
scientific
Science is a systematic discipline that builds and organises knowledge in the form of testable hypotheses and predictions about the universe. Modern science is typically divided into twoor threemajor branches: the natural sciences, which stu ...
experimentation; and
beneficence towards experiment participants. It is thought to have been mainly based on the
Hippocratic Oath, 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, one of the three U.S. judges who presided over the
Doctors' trial, 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, 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 an American professional association and lobbying group of physicians and medical students. This medical association was founded in 1847 and is headquartered in Chicago, Illinois. Membership was 271,660 ...
. 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 ...
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, 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, ) is a set of ethical principles regarding human experimentation developed originally in 1964 for the medical community by the World Medical Association (WMA). It is widely regarded as the cornerstone document o ...
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 US federal government created to protect the health of the US people and providing essential human services. Its motto is ...
to ensure ethical treatment of human research subjects, known as the Common Rule, 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 regulatory law, regulations promulgated by the executive departments and agencies of the federal government of the ...
. These regulations are enforced by Institutional Review Boards (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, freedom ...
was adopted by the United Nations
The United Nations (UN) is the Earth, global intergovernmental organization established by the signing of the Charter of the United Nations, UN Charter on 26 June 1945 with the stated purpose of maintaining international peace and internationa ...
, 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 an applied ethics principle that a person must have sufficient information and understanding before making decisions about accepting risk. Pertinent information may include risks and benefits of treatments, alternative treatme ...
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 list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
.[ Another notable symposium review was published by the ]Medical University of Vienna
The Medical University of Vienna (MedUni Wien, German language, 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, foun ...
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
The federal judiciary of the United States is one of the three branches of the federal government of the United States organized under the United States Constitution and laws of the federal government. The U.S. federal judiciary consists primaril ...
.
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