Section 4. Readings
The Ethical Considerations of Medical Experimentation on
Human Subjects
by Manny
Bekier, M.S.
November 18,
2010
A critical examination of the ethics of medical experimentation on human
subjects, focusing on the medical experiments conducted on human subjects by
the doctors in Nazi Germany, as well as, in post-war U.S. may contribute to
a greater effort to curb potential abuse. In this endeavor, it is necessary
to understand the prevailing principles that guided the medical profession
in Nazi Germany in pursuing their heinous actions.
Why is this so relevant today? After all, this happened in the past, and not
even in the U.S., an aberrant culture created by a totalitarian regime over
65 years ago that no longer exists. Will such an examination help in
confronting biomedical issues today?
In 2010 United States Secretary of State Hilary Clinton apologized for
syphilis and gonorrhea experiments conducted on Guatemalans between
1946-1948 without their knowledge or permission. These experiments involved
696 subjects, male prisoners and female patients in the National Mental
Health Hospital of Guatemala. What is especially shocking is the fact that
60 years later the public learned about these unethical experiments
co-sponsored by the U.S. Public Health Service, the NIH, the Pan American
Health Organization and the Guatemalan government:
http://www.commondreams.org/headline/2010/10/01-6. The fact
that these experiments were considered, approved and initiated only a year
after the trial of the Nazi doctors and their dreadful experiments on human
subjects, makes this subject especially relevant.
Dr. Arthur Caplan, a noted medical ethicist stated at a biomedical ethic
conference,” The whole discipline of biomedical ethics rises from the
ashes of the Holocaust”. (Robert Leiter, Tainted Science, Jewish
World, July 14-20,1989). When we examine these past events, do we have the
right to sit in judgment and make moral pronouncements?
The relevance for today cannot be overstated. In looking over the many
documents available today, we might want to consider first whether we can
make the argument that we are in a position to make retrospective moral
judgments. Can we retroactively sit in judgment of the doctors who performed
medical experiments on prisoners in the concentration camps? These crimes
were so enormous and so grossly immoral that they should not be so casually
dismissed by citing some principle reflecting cultural ethical relativism
(i.e. “you can’t judge people of that time, in that place, by our standards
today”; - “there was a war going on and a suspension of normal rules are to
be expected”). Can we simply state that since there was a war putting
Germany in danger, extraordinary means were justified? Many people today
might agree that extraordinary danger excuses extraordinary means to serve
the common good. Despite the fact that such a belief totally rejects human
rights, one is prevented from offering any judgment of these actions
according to the principles of cultural ethical relativism.
The position one takes on retrospective moral judgment has serious
implications on what one should be doing today. If one cannot judge that
human rights were seriously violated in Nazi Germany, one cannot argue that
human rights are being violated today. If morality is to have any validity
today, clearly the arguments of cultural ethical relativism should be
totally rejected.
Alan Buchanan states that there can be no moral progress unless we are able
to apply the same moral yardstick to the past and the present. The passage
of time does not affect the validity of moral judgment (Ronald Munson,
Intervention and Reflection, p. 525). The fact that 65 years have passed
does not diminish the evil manner in which the Nazi medical experiments were
conducted. The American Nuremberg Military Tribunal judged some of the key
doctors. (The Nuremberg Trials).
Some may wonder what is one to gain by issuing judgments of culpability?
Shouldn’t this energy be focused on the future? Shouldn’t efforts be made to
ensure that these wrong doings do not occur again? As Allan Buchanan stated,
it would be a serious mistake to assume the choice must be to either
make judgments of culpability or to focus on future prevention.
(Munson,
p.530).
The Nuremberg Code of 1947 came into being as a result of the heinous human
experimentation performed by the Nazi doctors in the many concentration
camps throughout the German Third Reich. The judgment by the war crimes
tribunal, as a result of the “Doctors Trial” at Nuremberg, established
10 principles to guide physicians in all human experimentation:
http://www.cirp.org/library/ethics/nuremberg/. Prior to the
Nazi war crimes tribunal, there was no written international code for
doctors. Lawyers defending the Nazi doctors pointed to events in the U.S.,
attempting to argue, for example, that similar wartime experiments were
conducted with prisoners at the Illinois State Penitentiary, who allegedly,
deliberately infected prisoners with malaria
http://www.whale.to/a/cantwell9.html.
The experience of the Nazi medical experiments performed in the
concentration camps has made it painfully aware that medical experiments on
human beings need to conform to well-defined ethical standards and should
supersede the justification that such experiments may yield results for the
“greater good of society” that might not be obtained by other methods or
means of study. The first principle of the Nuremberg Code clearly states,
“The voluntary consent of the human subject is absolutely essential”. This
is followed by an explicit clarification of all the associated requirements,
making it extremely difficult for research principle investigators to twist
it’s meaning:
http://www.ushmm.org/research/doctors/Nuremberg_Code.htm
For an informed consent to be considered ethically valid, there must be full
disclosure. This entails that the potential participant must be thoroughly
informed as to the purpose of the research, the procedures to be used, the
benefits to the participant, if any, and the potential risks and discomforts
of participating in the research. Any deception jeopardizes the integrity of
the informed consent process. There should also be assurances of
confidentiality or anonymity of the participant. The participant's consent
to participate in the research must also be voluntary and free of any
coercion. It is vital that the participant understand what has been
explained and be given the opportunity to ask questions. It is also
necessary that the participant be competent to give consent. In the absence
of competency, a legally approved advocate may provide consent.
Participation in the research study should be authorized, preferably in
writing. Everything should be clearly stated in an informed consent
document, written in an easily understood format that avoids or explains
technical terms, and whom to contact with further questions:
http://depts.washington.edu/bioethx/topics/resrch.html#ques1.
The principles established by the Nuremberg Code for medical practice were
modified and somewhat weakened in less than a year by the Declaration of
Geneva, by modifying consent from "absolutely essential” to "if at all
possible." Now doctors were given the latitude to obtain consent “if at all
possible” and research was allowed without consent where proxy consent was
given (Article II.1) Over the years the regulation of medical research
continued to evolve. The World Medical Association adopted the Declaration
of Helsinki in June 1964. Since then it has undergone various revisions, the
last one, sixth revision, in October 2008. No doubt there will be a further
evolution of ethical guidelines as new issues in research develop:
http://en.wikipedia.org/wiki/Declaration_of_Helsinki.
Looking at the medical experimentation performed on human beings under the
Nazi regime, one will begin to understand why the effort was made to develop
the Nuremberg Code, and the rationale for holding the participating doctors
accountable for their actions. In reality the medical experiments conducted
by the Nazi doctors were only a small part of the grand scale of systematic
medical killing of the Third Reich. (Robert J. Lifton, The Nazi Doctors,
New York: Basic Books, 1986, p. 269).
The Subjects
All records indicate that the subjects (prisoners) did not consent to any of
the experiments. In many cases, experiments were performed by unqualified
persons and under the most horrendous physical conditions. All of the
experiments were conducted with no thought or precautions to the wellbeing
of the subject from the possibilities of injury, disability, or death. In
virtually all the experiments the subjects experienced extreme pain,
resulting in permanent injury, mutilation, or death:
http://www.ushmm.org/research/doctors/Nuremberg_Code.htm.
The Doctors
The Medical Case, the first of twelve Nuremberg proceedings, began on
October 25, 1946. Twenty-three physicians, scientists, and other senior
officials in the Nazi medical administration were put on trial. Seven of the
accused were sentenced to death and executed; nine were given prison
sentences; and seven were acquitted. Several major perpetrators were able to
evade prosecution:
http://www.ushmm.org/research/library/bibliography/?lang=en&content=medical_experiments.
These twenty-three physicians hardly reflect the many medical participants
conducting unethical medical experiments during the Third Reich. The
majorities of the doctors were able to evade punishment and simply vanished,
or, as in most cases, were reabsorbed into the medical community to continue
their practice. The trial documents and evidence related to this case amount
to approximately 2800 documents and 13,000 pages of material:
http://nuremberg.law.harvard.edu/php/docs_swi.php?DI=1&text=medical.
The prosecuting attorney at the Nuremberg Trials, General Telford Taylor
expressed it succinctly, “This policy of mass extermination could not
have been so effectively carried out without the active participation of
German medical scientists.”
http://www.law.umkc.edu/faculty/projects/ftrials/nuremberg/doctoropen.html.
Who were these doctors, what influenced their thinking and how did they
justify their actions in which they turned themselves from healers into
murderers? When one considers Nazi medical experimentation, the name of Dr.
Mengele is the name that most often comes up. Although he performed ghastly
experiments on nearly 1,500 sets of imprisoned twins at Auschwitz and is
considered by many, the most notorious of the Nazi doctors, he was hardly
alone. He was not even the highest-ranking physician at Aushwitz (SS captain
Dr. Eduard Wirths was the physician in charge at Auschwitz):
http://www.ushmm.org/wlc/en/article.php?ModuleId=10007060.
Dr. Mengele M.D., PhD was hardly the crazed mad scientist portrayed in the
motion picture The Boys From Brazil.
The medical profession in Germany, until several decades ago, attempted to
cover-up the role played by the Nazi doctors rather than trying to
understand what had happened and how it was allowed to happen, and the
subject has remained taboo.
Attempts were made in the post war years to characterize these doctors, as a
lunatic fringe, on the fringe of the medical profession. We were presented
with myths of incompetence, madness on the part of a few, and coercion.
William Shirer (author of The Rise & Fall of the Third Reich)
described the Nazi doctors as “irrational psychopathic butchers” on the
fringes of professional medicine (W.L. Shirer, The Rise and Fall of the
Third Reich, Greenwich, Conn: Fawcett, 1962). In reality, these doctors
were not madmen, nor insane and this is why it requires critical examination
of the medical profession to understand their behavior. It would be
irresponsible to simply caricaturize the Nazis doctors and scientists as
mad, irrational or devoid of conscience. These doctors, many of whom, were
the leading professionals in their fields, were highly regarded by their
peers throughout the world. It was some of these internationally recognized
doctors who were in the forefront of giving credibility to Nazi racist
theories.
The Thinking
How does one explain the attraction to National Socialism? 45% of the
physicians in Germany became members of the Nazi Party. This was the highest
ratio of Nazi party membership of any profession. By 1942, more than 38,000
doctors joined Nazi Party (almost 50%). The attraction was the biomedical
vision with its emphasis on biology, research support, as well as, career
opportunities.
The Nazi biomedical vision included the belief that certain “races” are
superior to others; that scientific management could solve social problems
(preventing the propagation of the “unfit”); the conviction that mental
illness justified compulsory sterilization, and the measure of individual
worth be in economic terms (reduce the cost of the defective or
non-productive population). The overall vision was a lofty one: to improve
the genetic composition of their citizenry in hope of creating a society in
which individuals would be economically useful. These beliefs reflected
basic utilitarian moral principles.
The rationale of these utilitarian principles can best be illustrated by
examining the text of a speech by Dr. Walter Groß, the head of the Nazi
Party’s Office of Racial Policy (October 13, 1934). “A single mentally
ill Negro of English citizenship lived for 16 years in an institution in
Berlin, costing 26,000 Marks. 26,000 Marks were thrown away on a life that
had no meaning. 26,000 Marks that could have been used to prepare a dozen
strong, healthy, and gifted children for life and a job. We went so far as
to put the sick and the dying before the young, strong, healthy and
promising. That is against nature and life. A nation going this way is
heading for the abyss.”
http://www.calvin.edu/academic/cas/gpa/gross.htm.
With these utilitarian principles, the Nazi government was able, through
their T4 program, to euthanize (a euphemistic term meaning “good death”) at
least 5,000 physically and mentally disabled German children. These children
were categorized as “life unworthy of life” (one of many Nazi euphemisms
justifying murder):
http://www.ushmm.org/wlc/en/article.php?ModuleId=10005200.
The Office of Racial Policy was also prepared to rebut any arguments
postulating divine law or natural law. In the same speech Dr. Groß,
delivered the Nazi perverted perspective of natural law,“It is true that
we are subject to a higher power. We humans may never interfere with the
great laws of the Creator. But you are wrong. See the laws the Creator has
established for his world and your life. The great law is that life must be
able to preserve itself, and that if it cannot, it will collapse. It is the
hard, brutal law of the struggle for existence and of selection and
extinction.”
http://www.calvin.edu/academic/cas/gpa/gross.htm.
To gain insight into the ethical issues that prevailed, it is necessary to
understand the evolutionary ethics that prevailed in Nazi thought. Rudolf
Hess, the Deputy Führer, came right to the point when he described National
Socialism as “nothing but applied biology” (Lifton, p.129). This kind of
thinking did not originate with the Nazis. This “biomedical vision” has a
long history:
http://www.trufax.org/avoid/nazi.html. This can best be
understood by reading this medical interpretation of the Nazi ideology in
which Germany was viewed as being ill and Hitler was sent as the doctor.
(Please note the euphemism of the enemies within as “bacteria”). “When
the Führer took power in 1933, the German people’s body was severely ill.
The poison of foreign worldviews ran through the veins of all the people’s
organisms. Hardly anyone was immune. Then Providence sent the German people
a doctor, the Führer. He knew the disease; he knows the German people
suffered from a corruption of its racial strength. Using every possible
medication, including if necessary the most radical, the bacterium was
removed from the people’s body. Our people are becoming racially healthy
once more.”
http://www.calvin.edu/academic/cas/gpa/erblehre.htm.
It is interesting to note that natural law was considered central to the
legal theory for the prosecution of these Nazi doctors during the Nuremberg
trials. Natural law is a view that certain rights or values are inherent in,
or universally recognized, by virtue of human reason or human nature. Since
natural law, whose guiding principles are set by nature, are considered
self-evident and have validity everywhere, the prosecution felt that it
could serve as the standard to criticize the laws established by the Nazi
regime. The prosecution had to rely on natural law theory because most of
the actions of the Nazi doctors were recognized as being legal under the
judicial system of the Third Reich. In fact, the Nazi defendants claimed
they were merely following the established laws of the nation. They were not
killing by their own authority, but obeying the laws of the state, which can
determine the method of death. Even if a law is viewed as repulsive, one
cannot deny legality. The law is no less legitimate as law merely because
people find it morally reprehensible:
http://bad.eserver.org/issues/2004/69/swartz.html.
In addition to claiming they were acting within the law, the Nazi doctors
justified their actions by what they considered to be moral reasons. To
mention a few: law takes precedence over ethics; the good of the many is
more important than the good of the few; national emergencies supersede
ethics; to improve society by social engineering based on eugenic theories;
some groups can lose their claim to humanity; some people were sub-humans
(racially inferior) and were equated with vermin; Jews were a threat to
society and the family.
The Ethics
All medical research had a purpose and ultimately was designed to help the
German military effort, such as developing new weapons, testing
pharmaceuticals and aiding in the medical treatment of military personnel
who had been injured, as well as advancing the racial ideology of the Nazi
regime:
http://www.ushmm.org/wlc/en/article.php?ModuleId=10005168.
Consequently, the doctors during the Nazi regime felt that they were doing
wonderful work for humanity. This raises a critical issue. The doctors in
Germany took the Hippocratic Oath, yet they knowingly violated the
Hippocratic principle of “do no harm”. How were they able to reconcile this
glaring contradiction?
To begin to address this contradiction, an examination must be made of some
of the moral premises utilized. One of the premises already cited was the
exclusion of some ethnic groups’ claim to humanity. In Nazi Germany, Jews
were, through a series of laws known as the Nuremberg Laws, methodically
excluded from society, becoming non-persons.
The racial policies developed had a strong grounding in genetics and
evolutionary biology. One need only look at some of the many written
explanations by the Nazi government to prevent offspring with hereditary
illnesses.“In the case of plants and animals cultivated by humans, care
is taken to weed out the less valuable. Only the useful and valuable genetic
material is preserved. That is also what nature wants through the law of
selection. Should not we do the same with people? Or shall the lines of our
people with hereditary illnesses overcome the healthy? That would mean the
self-dissolution and destruction of the whole people, for a people that
suffers from hereditary illnesses is not able to maintain itself in the
great battle of selection between the peoples!
To protect the healthy population from the dangers of hereditary illness and
dissolution, the National Socialist State created the “Law for the
Prevention of Offspring with Hereditary Illnesses “ of 14 July 1933. Under
this law, the genetically burdened are sterilized for the following
diseases…”
http://www.calvin.edu/academic/cas/gpa/erblehre.htm.
In line with this thinking, prisoners were not viewed as individuals, but
rather as “living culture” or rats, to be used with no consideration for
wellbeing. In most cases, rats were treated far better than Jewish
concentration camp inmates. In equating Jews with rats, a propaganda film by
Fritz Hippler, The Eternal Jew, was made to show Jews as a dangerous
parasitic race spreading disease. In this film, images of rats are
juxtaposed over derogatory images of Jews. The narrator explains the Jews'
rat-like behavior, while showing footage of rats squirming from sewers:
http://www.holocaust-history.org/der-ewige-jude/.
Since the doctors in Nazi Germany were guided by utilitarian moral
principles, they did not need to consider informed consent. The utilitarian
moral code has no need to consider informed consent. If more social good was
to be gained without securing agreement, that was all that matters and was
viewed as morally legitimate (Munson p.492). Utilizing utilitarian
principles, Nazi Germany had no difficulty designating the mentally
retarded, habitual criminals, the physically handicapped, patients with
chronic diseases, as those less valuable members of society, referred to as
“life unworthy of life”, and they could be legitimately sacrificed to
improve life for the majority of the population. It is interesting to note
that the definition of mentally retarded and undesirable was expanded over
time to include anyone opposed to the Nazi regime.
According to Kantian principles (the categorical imperative), people cannot
be forced to accept treatment or be subject to medical experimentation for
“the good of the majority”. The Kantian view states that people should
always be treated as “ends”, and never as “means” only. Therefore it is
implicit with Kantian principles that a society cannot use a part of the
population as slaves, as this treats them merely as means. By exploiting a
part of the population for the gain of the rest, or even to exploit a single
individual would reflect utilitarian principles. The medical experiments
performed by the doctors in the concentration camps were predominantly
utilitarian in nature. It should be noted that not one of the prisoners
voluntarily waived their rights as human beings in order to sacrifice
themselves for the alleged greater good of German society. That option was
never a consideration, as the prisoners were considered “less than human”.
The Experiments
Between 1939 and 1945, at least seventy medical research projects involving
cruel and, often, lethal experimentation on human subjects were conducted in
Nazi concentration camps:
http://www.ushmm.org/research/library/bibliography/?lang=en&content=medical_experiments.
There were a great many doctors at so many concentration camps performing a
wide range of medical experimentation. For a brief description of these
doctors and the medical crimes they committed, see:
http://www.webster.edu/~woolflm/nazidocsandothers.html.
In addition to the infamous Mengele’s medical experiments on twins, there
were freezing experiments, high altitude experiments, malaria experiments at
Dachau and Aushwitz; muscle and nerve regeneration, bone transplantation
experiments, and sulfonamide experiments at Ravensbrück concentration camp;
mustard gas experiments at Sachsenhausen, Natzweiler; sea water experiments
at Dachau; sterilization experiments at Auschwitz, Ravensbrück and other
places; and experiments with poison and phosphorus burn experiments at
Buchenwald. For a comprehensive list of the medical experiments and other
medical crimes, see the indictments (Oct. 25, 1946) of the Nuremberg
Military Trial Case 1:
http://nuremberg.law.harvard.edu/php/docs_swi.php?DI=1&text=medical
Also see:
http://www.law.umkc.edu/faculty/projects/ftrials/nuremberg/nurembergdoctortrial.html.
The Nazis’ experiments on human subjects are well documented. There
were so many doctors, at so many camps doing a wide range of cruel,
unethical experiments. Even medical students were afforded the opportunity
to practice and operate on people, regarding their specialty. One can
imagine, for the research scientists and sponsoring pharmaceutical
companies, this was paradise. Imagine having an endless supply of “live
human materials” on which to test any medical hypothesis.
The results of many of these experiments were not exactly a secret. Findings
were regularly published and distributed to the German medical profession
and in a number of postwar scientific publications. In fact there is an
abundance of documentation on these experiments. This paper will only focus
on two types of experiments, as they are examples of ethical issues related
to post-war experiments conducted in the U.S. and ethical issues we are
still confronting today.
Citing first, the Freezing / Hypothermia experiments done at Dachau, as
society was presented with the ethical issue of utilizing the medical data
from these experiments in 1989:
http://www.nytimes.com/1989/05/21/us/nazi-scientists-and-ethics-of-today.html?pagewanted=all.
Citing second, the radiation experiments done at Aushwitz (objective to mass
sterilize unsuspecting prisoners), as the U.S. government sponsored
radiation experiments on some of the most vulnerable members of our society,
long after the verdicts for this crime was handed down at the Nuremberg
Tribunal.
The freezing / hypothermia experiments were conducted on men to simulate the
conditions suffered by many of the soldiers of the German armies on the
Eastern Front. The objective of the researchers was to find the best medical
response for the thousands of German soldiers who were freezing to death and
those soldiers debilitated by the cold. The experiments were designed to
find the most effective way of rewarming German aviators who were forced to
parachute into the North Sea.
The experiments were conducted primarily at Dachau, under the supervision of
Dr. Weltz and his assistant, Dr. Sigmund Rascher. The results of Dr.
Rascher’s freezing experiments were publicized at the 1942 medical
conference entitled "Medical Problems Arising from Sea and Winter":http://remember.org/educate/medexp.html.
Dr. Weltz also spoke on the subject "Warming up after Freezing to the Danger
Point."
http://www.ess.uwe.ac.uk/genocide/Medical%20Case%20Trial%20Prosecution2.htm.
The freezing experiments were divided into two parts. First, to establish
how long it would take to lower the body temperature to the point of death,
and second how to best resuscitate the frozen victim. The subjects of these
experiments were young healthy Jews or Russian prisoners of war.
The two main methods used to freeze the victim were to put the person in an
icy vat of water (the fastest way to drop the body temperature) for up to
eight hours at a time, or to put the victim outside naked, strapped to a
stretcher, in sub-zero temperatures for 9 to 14 hours, as the victims
screamed with pain as their bodies froze.
The resuscitation or warming experiments by various means were equally as
cruel and painful to the subjects as the freezing experiments, and resulted
in horrible deaths:
http://remember.org/educate/medexp.html.
The results, or “data” from these experiments has raised serious medical
ethical issues today. Is it ever appropriate to use data as morally
repugnant as that, which was extracted from victims of the Nazi medical
experiments conducted in the concentration camps? Simply put, is it ethical
to use data gathered unethically? And if we're faced with this kind of
situation again, how are we to respond? Furthermore, are there any
circumstances where using such data is ethically permissible? It was these
questions that brought together approximately 200 scholars for a conference
in Minnesota in 1989:
http://www.nytimes.com/1989/05/21/us/nazi-scientists-and-ethics-of-today.html?pagewanted=all.
Behind the discussions was the fear that without ethical guidelines there
could be future scientific abuses like those committed under the Nazi
regime. The participants spent much of their time debating how the data from
the Nazi experiments should be used, if at all.
The Use of Medical Data
The results of those studies have been available to medical researchers
since the end of World War II. But in recent years several scientists who
have sought to use the Nazi research have stimulated public controversy by
raising the issue of social responsibility and potential abuses of science.
It was not until Dr. Robert Pozos, a researcher on hypothermia, raised the
ethical issue of whether he should utilize Nazi data collected on
hypothermia, was there so much public attention drawn to this issue. Pozos’
research focused on the methods of rewarming frozen victims of cold. Pozos
had to speculate what the effects would be on a human being at freezing
temperatures. The only ones that put humans through extensive hypothermia
research were the Nazis:
http://www.jlaw.com/Articles/NaziMedEx.html. Pozos had simply
been the first scientist to raise the question publicly whether all this was
ethically acceptable. However, he was hardly the first to use Nazi research
data. The Journal of the American Medical Association (JAMA) published an
article (July 1946) by Dr. Molnar, a University of Rochester physiologist,
who expressed no sense of any ethical ambiguity while writing about
hypothermia survival based on Nazi data. In 1983, John S. Hayward at the
University of Victoria used the Nazi hypothermia data to test survival suits
carried in fishing boats in the freezing Canadian Arctic:
http://articles.latimes.com/1988-10-30/news/mn-958_1_nazi-data-issue/6.
According to the Hastings Center Report, there were at least 45 research
articles published since the end of World War II that cited data from Nazi
experiments:
http://articles.latimes.com/1988-10-30/news/mn-958_1_nazi-data-issue/6.
The bioethical conference, initiated by Dr. Pozos’ questions was never
satisfactorily resolved. "Ethicists never answer a question," Pozos said.
"They raise one question, which raises another question and another. I want
guidelines. I want to know if the data is good, should we use it? Or should
the data forever be banned?"
http://articles.latimes.com/1988-10-30/news/mn-958_1_nazi-data-issue/6.
A significant number of scholars who attended felt that they should apply a
moral judgment, but let the data be used.
''The question is not whether we should use the data, but how,'' said Dr.
Robert Proctor, chair of the Science, Technology and Power at the New School
for Social Research. According to Dr. Proctor, ''It should be used if the
circumstances under which it was conducted are acknowledged and could be
dedicated to the memory of the victims”. Others, such as Dr. Arthur Caplan,
a bioethicist and an organizer of this conference, stated ''I don't think
lives hang in the balance, I think we can find out what we need to know from
other sources”:
http://www.nytimes.com/1989/05/21/us/nazi-scientists-and-ethics-of-today.html?pagewanted=all.
But what if lives hang in the balance? If the intended benefit were to save
lives, wouldn’t most agree that the data should be used? There are many who
would agree that the data should be used when lives are at stake. This is an
especially strong argument when there is no other alternative source from
which to gain that information, and the capacity to save lives is clearly
evident. Some scholars suggest a compromise solution, in which researchers
be allowed to make full use of the Nazi data and simultaneously denounce and
condemn the Nazi doctors and their experiments. With this concept, the
researchers using the Nazi data must be prepared to expose the Nazi doctors'
immoral experiments as medical evil, never to be repeated. "If Pozos
dedicated his study to the memory of those victims of the Nazis, it would
serve as a nice way of reminding people about the horrible experiments,"
said the Israeli director of The Simon Wiesenthal Center, Dr. Ephraim Zuroff:
http://articles.latimes.com/1988-10-30/news/mn-958_1_nazi-data-issue/6.
This convenient solution bears some moral hypocrisy. When researchers use
Nazi data, legitimacy is indirectly conferred on the data used. The ethical
guidelines condemning the means used in acquiring the data would be severely
undercut:
http://www.jlaw.com/Articles/NaziMedEx.html.
Professor Henry K. Beecher of Harvard Medical School, said that even though
suppression of the data would constitute a loss to medicine: "this loss,
it seems, would be less important than the far reaching moral loss to
medicine if the data were to be published." Beecher feels that, even
though Nazi data might benefit some lives, greater ethical issues arise:
http://www.jlaw.com/Articles/NaziMedEx.html. Dr. Howard
Spiro, Chairman Emeritus of the Department of Internal Medicine at the Yale
School of Medicine, expressed the ethical issue succinctly in a Letter to
the Editor of the New York Times (4/19/88) “No one honors the memory of
the dead victims by ''learning'' from experiments carried out on them.
Instead, we make them our retrospective guinea pigs. Any data obtained in
the Nazi concentration camps seems unlikely to be irreplaceable except in
their horror.” He also stated that this will “put us at risk of
retrospectively participating in their torture and death.” “If expressing
revulsion means losing something of value, then we should continue to
express our revulsion, particularly if we want to teach our children, and
our students, what they should not do”.
Radiation Exposure Experimentation
Having mentioned the Nazi experiments of hypothermia and their ethical
implications today, attention is directed to the Nazi sterilization
experiments using radiation. The example of radiation exposure experiments
has been specifically chosen for discussion, among the many categories of
Nazi medical experimentation, because scientists in the U.S., having the
knowledge of the verdicts of the medical crimes (Nuremberg Trials),
conducted radiation exposure experiments on our citizens. There are a number
of cases illustrating our use of radiation exposure experiments:
http://www.ppecorino.com/BOOKS/MEDICAL_ETHICS_TEXT/Chapter_7_Human_Experimentation/Case_Presentation.htm
Sterilization experiments were conducted at Auschwitz, Ravensbrück, and
other camps from March 1941 to January 1945. The purpose of these
experiments, conducted by Dr. Carl Clauberg, was to develop a method of
sterilization that would be capable of sterilizing millions of people with a
minimum of time and effort.
Carl Clauberg was a highly respected professor and gynecological researcher.
He was regarded as one of the most respected individuals in German medical
society. In December 1942, Carl Clauberg came to Auschwitz and was given
Block 10 for his medical experimental activities. Several hundred Jewish
women from various countries were placed in Block 10. The experiments
performed on these women were conducted by means of radiation, surgery and
the use of drugs. Clauberg developed a method of non-surgical mass
sterilization that consisted of injecting into the female reproductive
organs a specially prepared caustic substance that produced severe
inflammation:
http://www.shoah.dk/doctors/clauberg.htm.
The women were coerced to submit to this experimentation with the implied
threat from Clauberg that he would send them back to Birkenau (which meant
the gas chamber). Those women who refused, or who were considered
unsuitable or debilitated, were sent to Birkenau, where they were usually
gassed (Lifton, p.272). In his correspondence with Himmler, Clauberg refers
to the women for his experiments as “the human material to be provided”
(Lifton, p.275).
Thousands of victims were sterilized. Radiation treatment, however, became
the favored method of sterilization. The radiation was administered through
an established procedure based on deceit. Prisoners were brought into a room
and asked to complete forms, which took several minutes. During this time,
the radiation treatment was administered and unknown to the prisoners, they
were rendered completely sterile. As a result many suffered severe radiation
burns. The consequences were that many victims became unfit for work and
were gassed in the gas chambers, or died as a result of the burns:
http://en.wikipedia.org/wiki/Nazi_human_experimentation.
The objectives of Dr. Clauberg’s experiments are clearly expressed in his
letter to Himmler of June 1943, “I shall be able to report in the
foreseeable future that one experienced physician, with an appropriately
equipped office and the aid of ten auxiliary personnel, will be able to
carry out in the course of a single day the sterilization of hundreds, or
even 1,000 women.” (Lifton p. 276).
There were other radiation experiments in the camps, aside from Dr.
Clauberg’s. Dr. Horst Schumann was also searching for a practical means of
mass sterilization. Schumann was one of the leading figures in the Nazi
Euthanasia program (code name T4). He was director of the killing center at
Grafeneck and later a member of project 14f13, medically sanctioned killing
in the concentration camps (Lifton, p.278). The objective of Schumann’s
medical experiments was to develop assembly-line sterilization in which the
ignorant victims would not be aware of what was happening to them (Lifton,
p. 279)."X-ray sterilization" equipment was set up for Schumann at Birkenau.
He was provided with a large room containing two extensive X-ray machines
and a booth protected by lead plates to protect him from radiation (Lifton,
p. 281). The sterilization experiments consisted of exposing the women's
ovaries and the men's testes to radiation. The exposure to high intensity
radiation produced severe burns on the victims that would not heal. It is
estimated that approximately 1,000 prisoners, male and female underwent
radiation sterilization or castration, and about 200 of these were subjected
to surgical removal of testicles or ovaries. This data is based on
relatively accurate surgical records of these experiments conducted at
Auschwitz (Lifton, p. 283).
General Telford Taylor, the prosecutor at the Nuremberg Trials, summed up
for the prosecution the true intent of these sterilization experiments,
“We will show that in some instances the true object of these experiments
was not how to rescue or to cure, but how to destroy and kill. The
sterilization experiments were it is clear, purely destructive in purpose.”
http://www.ess.uwe.ac.uk/genocide/Medical%20Case%20Trial%20Prosecution1.htm
Post War U.S.
Radiation Exposure Experimentation
Hardly several years passed since the Nuremberg Trials and U.S. scientists
were already actively engaged in secret radiation exposure experiments. Were
these scientists oblivious to the medical crimes prosecuted at Nuremberg?
Were they oblivious to the Nuremberg Code with its first principle of
“informed consent” that was adopted to prevent such abuse? Or was the
utilitarian argument of the “Cold War” or bending other ethical theories
holding greater sway?
There were a number of cases in the post war years illustrating our use of
radiation exposure experiments:
http://www.ppecorino.com/BOOKS/MEDICAL_ETHICS_TEXT/Chapter_7_Human_Experimentation/Case_Presentation.htm
The experiment that took place at a state residential school in Fernald,
Massachusetts, is one of many radiation experiments. Knowledge of this and
other radiation testing experiments resulted from the declassified
government documents made available in 1993. In this experiment, which was
conducted from 1946 - 1953, Professor of Nutrition, Robert Harris studied
the absorption of calcium and iron by feeding 125 mentally challenged
children of the Fernald School, milk and cereal that contained radioactive
tracers. This was a joint experiment by Harvard and MIT, which included a
research fellow sponsored by the Quaker Oats Company, in addition to working
in cooperation with senior members of the Fernald staff. Young male children
were exposed to tracer doses of radioisotopes. These non-therapeutic
nutritional studies with radioisotopes were accomplished by deceiving the
parents of the boys by having the boys join a "Science Club", and further
enticing them with larger portions of food, parties, and trips to Boston Red
Sox baseball games:
http://en.wikipedia.org/wiki/Walter_E._Fernald_State_School.
In one study, the fifty-seven club members were fed cereal along with
radioactive tracers. In another study seventeen children were exposed to
radioactive iron via injection. The doses involved were low and the
researchers felt that it would be extremely unlikely that any of the
children who were used as subjects would be harmed:
http://www.hss.energy.gov/HealthSafety/ohre/roadmap/achre/chap7_5.html.
When news of these experiments reached the public, MIT issued the following
news release “At a news conference on May 9, the Task Force on Human
Subject Research announced its conclusion that the subjects in the radiation
experiments done by MIT and Harvard University researchers in the early
1950s were not exposed to dangerous levels of radiation.” The Vice
President and Dean for Research J. David Litster of MIT tried to focus
public attention to the fact that no harm was done to the “participants”. He
stated, "I am pleased that the task force has confirmed MIT's initial
impression that no harm was done to the participants in the cereal nutrition
studies that were the initial focus of publicity”.
http://tech.mit.edu/V114/N28/fernald.28n.html (an MIT
newspaper).
Utilitarian principles were convincingly argued to justify these
experiments. The purpose of these studies was to “improve understanding of
nutritional processes in order to promote health in young people and the
children used were protected and compensated”. Hans Jonas, an influential
German philosopher, argued the implications of such experiments that expose
individuals to dangers for the common good.
“We should not feel the need to participate in any medical experiment for
the sake of progress”.
http://www.ppecorino.com/BOOKS/MEDICAL_ETHICS_TEXT/Chapter_7_Human_Experimentation/Readings.htm
Although John Rawls did not develop the theory of distributive justice until
much later, these experiments showed a total lack of concern for individuals
viewed as “least advantaged in our society”. How was it that the Fernald
School was chosen for these experiments? Why wasn’t one of the many elite
private schools in Massachusetts chosen, one were the wealthy send their
children? At least in one of those schools, the children might have a better
understanding as to what they were participating in, and certainly the
parents would also be less likely to be unduly persuaded. The fact that a
school for mentally challenged children was chosen among all the possible
schools makes this immediately ethically suspect. Any volunteer should have
had complete freedom and knowledge about an experiment before deciding to
participate. Hans Jonas makes his point by suggesting that medical
professionals who wish to become subjects should be considered first,
followed by the highly motivated, educated, and least dependent individuals:
http://www.ppecorino.com/BOOKS/MEDICAL_ETHICS_TEXT/Chapter_7_Human_Experimentation/Readings.htm
Nevertheless, these experiments cannot be cavalierly ethically dismissed
because no harm was done to the “participants”. Did the “participants” or
their legal guardians really know that they were participating? Was informed
consent properly utilized? Available evidence suggests that the information
provided to the parents of the children was, at best, incomplete. The letter
to the parents seeking permission makes no mention of any risks or the use
of a radioisotope and there was no basis to inform the parents that
the project was intended for the children's improvement. The researchers
also offered inducements, as well as, subtle coercion to secure cooperation:
http://www.hss.energy.gov/HealthSafety/ohre/roadmap/achre/chap7_5.html.
Although these experiment, by no means can be morally compared to the Nazi
experiments, the relevant issue is that this research project, one of many,
knowingly violated the principles laid down by the Nuremberg Code. The
critical question must be asked: Are there adequate safeguards today
to protect people from secret government experimentation? For the last
several decades we have witnessed the meteoric rise of genetic research and
genetic engineering. Will these advances in medical research re-awaken our
eugenic impulse to “play God”? (See the eugenics movement in the U.S. in the
1920’s and ‘30’s). Writing in the Columbia Journalism Review, Geoffrey Sea
states: “A startling fact about the experiments is that, despite the
documentation of hundreds of cases of unethical conduct resulting in lasting
damage to thousands of people, not a single physician or nurse, scientist or
technician, policy maker or administrator has yet come forward to admit
wrongdoing.”
http://www.whale.to/a/cantwell9.html.
Regardless of how medical researchers are able to reconcile their
wrongdoings, there is the need for an increase in scrutiny by ethical review
boards. It should be clear that medical researchers need comprehensive codes
of ethics in this age of technology and terror. The regulations governing
human experimentation are very important and require continuing attention to
ensure the ethical aspects of all human experimentation. It is incumbent
that medical researchers be made aware of their ethical obligations,
including the obligation to abide by government regulations and to “blow the
whistle” on unethical research.
The Current Situation
Due to the growing public concern for adequate protection of human subjects
in research, there are today many federal, state and institutional policies,
procedures and regulations. On July 12, 1974, the National Research Act
(Pub. L. 93-348) was signed into law, there-by creating the National
Commission for the Protection of Human Subjects of Biomedical and Behavioral
Research. The guidelines established by this commission after nearly four
years of deliberation, clearly defined the basic ethical principles that
should underlie the conduct of all biomedical research on human subjects.
These guidelines, referred to, as “The Belmont Report” will hopefully assist
in resolving the ethical problems that surround the conduct of research with
human subjects:
http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.htm.
These guidelines stress three ethical principles:
1. Respect for persons (autonomy of the individual and individuals with
diminished autonomy are entitled to protection).
2. Beneficence (the obligation to do no harm and to maximize possible
benefits).
3. Justice (fairness).
This last principle can best be illustrated by the experience of the Fernald
School, in which the subjects chosen were mentally challenged boys that
could easily be manipulated and taken advantage of. In addition, the
National Bioethics Advisory Commission (NBAC) was established by Executive
Order and signed by President Clinton on October 3, 1995.
NBAC identified and laid down broad principles to govern the ethical conduct
of research. To read their report, see:
http://bioethics.georgetown.edu/pcbe/reports/past_commissions/nbac_human_part.pdf.
Today, there are Institutional Review Boards (IRB), which are responsible
for the review and approval of all research involving human subjects and are
guided by the ethical principles as set forth in the "Belmont Report". The
standard IRB policy explicitly states that the use of human subjects in
research is not permitted until the IRB has reviewed and approved the
research protocol, and informed consent has been obtained from the subject
or the subject's legal representative:
http://research.downstate.edu/ethics/ethics.htm. At Downstate
Medical Center (where the author of this paper has a faculty appointment),
all regulations are stated in a highly comprehensive IRB Investigator’s
Procedure Manual for the Protection of Human Subjects, which is
available online:
http://research.downstate.edu/irb/irb_piguide.pdf. In
addition to making the “Belmont Report” mandatory reading, there is a
comprehensive training program and IRB certification is a requirement for
approval for all research at Downstate involving human subjects:
http://research.downstate.edu/irb/irb.htm.
Conclusion
In this age of so many medical advances, a humanistic perspective is hoped
for. It is important for us to bear in mind that medical progress is not an
unconditional commitment. A slower course of progress in the eradication of
disease will in no way threaten society, however an erosion of our moral
values does pose such a threat. We must bear in mind that it was the
ruthless pursuit of scientific progress and “applied biology” to improve the
overall health of German society, at the expense of those most vulnerable
and those denied recognition as human beings, that greatly contributed to
the moral decay of Germany.
The process of critically examining past history will hopefully prompt a
greater effort to curb potential abuse. As a result of retrospective moral
judgment ethical principles and resulting guidelines have evolved and
coupled with serious efforts to hold government officials and medical
researchers personally accountable for any wrongdoings will provide better
protection for human subjects.
Copyright ©
2010, Manny Bekier. All rights reserved. |