Unspeakably Cruel-Torture, Medical Ethics, and the Law

George J Annas

New England Journal of Medicine, NEJM
New England Journal of Medicine

Extract
The Nazi doctors defended themselves primarily by arguing that they were engaged in necessary wartime medical research and were following the orders of their superiors. These defenses were rejected because they are at odds with the Nuremberg Principles, articulated a year earlier, at the conclusion of the multinational war crimes trial in 1946, that there are crimes against humanity (such as torture), that individuals can be held to be criminally responsible for committing them, and that obeying orders is no defense.


Annas GJ. Unspeakably Cruel-Torture, Medical Ethics, and the Law. N. Engl. J. Med.. 2005;352(20):2127-2132.

War Crimes and Legal Immunities: The Complicities of Waffen-SS General Karl Wolff in Nazi medical experiments

Michael Salter, Suzanne Ost

Rutgers Journal of Law & Religion
Rutgers Journal of Law & Religion

Extract
There is a considerable amount of academic and popular literature on Nazi medical experimentation within concentration camps, however, the existing research largely focuses on the doctors and the details of their experiments and has neglected two interesting themes. The first neglected theme is the potential legal liabilities and defense strategies of those among the SS leadership, such as SS General Karl Wolff. Wolff facilitated these experiments in a purely administrative capacity, but without his contribution this type of war crime would not have been possible. Secondly, the research has neglected the extent to which Wolff was able to avoid legal accountability for these and other war crimes, as a result of his wartime cooperation with a U.S. intelligence agency and his post-war assistance to interrogators within the Allied Military Intelligence as well as the Nuremberg prosecutors. [2] The present article, which is the first in a series of related studies, focuses largely on the first theme. This article gives particular attention to Wolff’s attempts to avoid prosecution by insisting that the experiments were of a voluntary nature, based on the consent of the research subject, and were, therefore, not criminal acts. Additionally, the article focuses on Wolff’s claim that he did not possess the requisite mens rea or intent necessary to secure a criminal conviction.


Salter M, Ost S. War Crimes and Legal Immunities: The Complicities of Waffen-SS General Karl Wolff in Nazi medical experiments. Rutgers J Law Rel. 2004(1);1-69.

The Killing of Psychiatric Patients in Nazi-Germany between 1939-1945

Michael Von Cranach

Israeli Journal of Psychiatry and Related Sciences
Israeli Journal of Psychiatry and Related Sciences

Abstract
Between 1939 and 1945, 180,000 psychiatric patients were killed in Nazi Germany. This paper opens with a brief discussion of the reasons for addressing this issue today; it is followed by the details of the so-called euthanasia program that entailed killing of patients by gas in special hospitals in the years 1939-1941, and in psychiatric hospitals in the years 1942-1945. In this latter period, patients were killed with lethal injections and through the introduction of a starvation diet. The fate of the Jewish patients and forced laborers, as well as the experiments conducted on the patients, are mentioned. Finally, some thoughts are presented to answer the question of why this could have happened. To me, the giving up of individual responsibility in an authoritarian system leads to the loss of the individual conscience and soul, including those of a psychiatrist.


Cranach MV. The Killing of Psychiatric Patients in Nazi-Germany between 1939-1945. Israeli J Psych & Related Sciences. 2003;40(1):8-18

A presentation by the same title with a similar abstract was presented at a meeting of the Israel Psychiatric Association, Jerusalem, 6th of December 2001.

Medicine and Conscience: The Debate on Medical Ethics and Research in Germany 50 Years after Nuremberg

Michael Wunder

Perspectives in Biology and Medicine
Perspectives in Biology and Medicine

Journal Extract
“The question is whether we will ever be able to learn from history,” Alexander Mitscherlich said in 1947. He was a member of the German Medical Commission, who by order of the German General Medical Council witnessed the Nuremberg Trial. “I believe,” Mitscherlich continued, “that we won’t master it by just keeping our distance morally. This is doubtless easy to achieve. However, it is useless for us as soon as we think of the dark future of this century, in which situations might occur leading to a similar coldness and ignorance towards the right to live of people more defenseless and disregarded” [1]. 1

Over the ensuing decades, neither physicians nor the public faced the tiring process of reviewing and questioning history. Even the reports of the German Medical Commission met with a growing disinterest and disapproval from the physicians in post-war Germany. 2 Almost 50 percent of the German physicians were members of the NSDAP (Nazi Party), and they resumed their work after 1945 after only a brief interruption.

Thus it is understandable that it was not the physicians’ organizations nor the medical historical departments of the universities that turned towards history at the beginning of the1980s. Rather, it was their children [End Page 373] and grandchildren, who were working in the hospitals, the psychiatric institutions, and homes for persons with disabilities. They began to ask what happened 40 or 50 years ago where they were working. They were not involved personally, nor did they blame their fathers and mothers. This is the generation to which I also belong. 3

After Auschwitz and Hadamar, particularly in Germany, discussion about medical ethics and about the future of medicine are nowadays impossible without reference to history. 4 This consideration was the basis of the program entitled “Medicine and Conscience” in the German Section of International Congress of Physicians for the Prevention of Nuclear War, held in Nuremberg in October 1996. 5 As a result of this congress, on the 50th anniversary of the pronouncement of judgment in the Nuremberg Trial, 20 August 1997, the Nuremberg Code 1997 was presented. Based on the historical experiences and the fundamental ideas of the 1947 Code, the 1997 Code is designed to answer current medical questions about the application of biosciences to human beings. It discusses 10 topics, including medical experiments, reproductive medicine, genetic diagnostics and therapy, transplantation, euthanasia, and distribution of resources. (Due to the time limit and the theme of this symposium, I will focus only on the topic of medical research.) The Nuremberg Code 1997 follows the widespread practice of considering informed consent to be a prerequisite in all fields of public health care service.

The critical-historical link to the Nuremberg Code 1947 that we attempted to make with Code 1997 had to confront two fundamental issues. First, we had to determine whether the Code’s significance was only historical or universally valid. To put it differently: was the 1947 Code only to be understood from the historical context? Did it only aim at the judgment of the practices of the Nazi physicians? Or did it imply a universal validity for medical research and medicine in a civilized world?

Historical evidence, as well as a look at the text of the Code, clearly speaks for a universal validity. Telford Taylor, the chief prosecutor of Nuremberg, stated in his introduction that the trial was no mere murder trial, since the defendants were physicians who had sworn the Hippocratic oath and thus had become murderers in the execution of their profession. Logically, the judges created with the Nuremberg Code a basis for the judgment of crimes which became possible within the bounds of medicine. 6[End Page 374]


Wunder M. Medicine and Conscience: The Debate on Medical Ethics and Research in Germany 50 Years after Nuremberg. Perspect Biol Med. 2000;43(3):373-381.

Nuremberg lamentation: for the forgotten victims of medical science

William E Seidelman

British Medical Journal, BMJ
British Medical Journal

Abstract
Fifty years after the Nuremberg medical trial there remain many unanswered questions about the role of the German medical profession during the Third Reich. Other than the question of human experimentation, important ethical challenges arising from medicine in Nazi Germany which have continuing relevance were not addressed at Nuremberg. The underlying moral question is that of the exercise of professional power and its impact on vulnerable people seeking medical care. Sensitisation to the obligations of professional power may be achieved by an annual commemoration and lament to the memory of the victims of medical abuse which would serve as a recurring reminder of the physician’s vulnerability and fallibility.


Seidelman WE. Nuremberg lamentation: for the forgotten victims of medical science. Br Med J. 1996 Dec 7;313(7070):1463-1467.

Human guinea pigs and the ethics of experimentation: the BMJ’s correspondent at the Nuremberg medical trial

Paul Weindling

British Medical Journal, BMJ
British Medical Journal

Abstract
Though the Nuremberg medical trial was a United States military tribunal, British forensic pathologists supplied extensive evidence for the trial. The BMJ had a correspondent at the trial, and he endorsed a utilitarian legitimation of clinical experiments, justifying the medical research carried out under Nazism as of long term scientific benefit despite the human costs. The British supported an international medical commission to evaluate the ethics and scientific quality of German research. Medical opinions differed over whether German medical atrocities should be given publicity or treated in confidence. The BMJ’s correspondent warned against medical researchers being taken over by a totalitarian state, and these arguments were used to oppose the NHS and any state control over medical research.


Weindling P. Human guinea pigs and the ethics of experimentation: the BMJ’s correspondent at the Nuremberg medical trial. Br Med J. 1996 Dec 07;313(7070):1467-1470.

Nuremberg and the Issue of Wartime Experiments on US Prisoners

The Green Committee

Jon M. Harkness

Journal of the American Medical Association
Journal of the American Medical Association

Abstract
Defense attorneys at the Nuremberg Medical Trial argued that no ethical difference existed between experiments in Nazi Concentration camps and research in U.S. prisons. Investigations that had taken place in an Illinois prison became an early focus of this argument. Andrew C. Ivy, MD, whom the American Medical Association had selected as a consultant to the Nuremeberg prosecutors, responded to courtroom crticisim of research in his home state by encouraging the Illinois governor to establish a committee to evaluate prison research. The governor names a committee and accepted Ivy’s offer to chair the panel. Late in the trial, Ivy testified – drawing on the authority of this committee – that research on Us prisoners was ethically ideal. However, the governor’s committee had never met. After the trial’s conclusion, the report was published in JAMA, where it became a source of support for experimentation on prisoners.


Harkness J. Nuremberg and the Issue of Wartime Experiments on US Prisoners: The Green Committee. JAMA. 1996;276(20):1672–1675. doi:10.1001/jama.1996.03540200058032

Remarks on medical ethics

Martin Bojar

Journal of Medical Ethics
Journal of Medical Ethics

Extract
Fulfilling the universal code of medical ethics is the ‘conditio sine qua non’ and we should prevent all attempts to change the basic document of European and world medicine, the Hippocratic Oath. Pross’s paper about the total failure of the German Medical Association to acknowledge and deal with war crimes perpetrated by doctors reinforces the need to adhere to the Hippocratic Oath.


Bojar M. Remarks on medical ethics. J Med Ethics. 1991;17(Supplement):39.

(Correspondence) Ethics and Abortion

JP Crawford

British Medical Journal, BMJ
British Medical Journal

Extract
Surely a decision by Parliament in a democracy cannot be described as sinister ” superior orders” echoing Nuremberg 20 years ago (or rather what ended there and then). The boot could be argued to be on the other foot-namely, that doctors are prepared to dictate to the nation.


Crawford J. (Correspondence) Ethics and Abortion. Br Med J. 1968 Apr 20;2(5598):173.

(Editorial) Ethics and Abortion (Response)

British Medical Journal

British Medical Journal, BMJ
British Medical Journal

Extract
[Re: comparison of legal dictation of ethical norms to “superior orders” defense at Nuremberg] “It was a plea of ” superior orders ” in justification of a profession changing an ethical rule which we said would be the ” sinister echo ” not the superior orders themselves (in this case the provisions of the Abortion Act).”


BMJ. (Editorial) Ethics and Abortion (Response). Br Med J. 1968;2(5598):173.