The SRA Symposium - College of Medicine

Papers
Post-World War II
As of 2001, according to Kubar, there were in excess of 250 guidelines, declarations, codes and other
documents concerning bioethics. Between 1947 and 1998, 17 European countries and 15 Latin
American countries adopted more than 74 codes or guidelines concerning medical ethics. These
are clearly outgrowths of the Nuremberg Trials and the medical experiments those trials exposed.
Knowledge of experiments conducted by Nazi doctors on children, the mentally or physically
handicapped, the elderly, and inmates of concentration camps caused horror and revulsion around
the world. As a result of these atrocities and the Nuremberg trials, at which 23 Nazi doctors were
tried for their medical experiments on concentration camp victims, the American doctors who
had presided at the trials developed a ten-point code in 1947. The first, most basic and most discussed
tenet of the code requires explicit consent from human subjects prior to participation. Risk
and benefit are the subjects of the other nine items in the document. The Nuremberg Code is the
basis for a majority of the subsequent ethical guidelines.
Kious notes that, even with imperfections, this code provided guidelines where nothing had previously
existed, certainly there was no international consensus on the ethics of human experimentation.
But other issues require comment. Some populations that cannot give legal informed consent
are unique and have research needs that can only be studied in individuals belonging to that
group (children, the emotionally or psychologically impaired, the elderly). This code also requires
experiments with significant risk (“death or disabling injury”) to be first tried on the experimenter.
The requirement for animal experiments cannot work for conditions that have no animal model.
Kious also points out that this code does not provide a definition of human experimentation, nor
does it address the difference between therapeutic and nontherapeutic research.
Evans and Beck note that this code had little impact at the time. In fact, most American and British
researchers were of the opinion that it was not necessary, that the high motives and responsible
nature of researchers obviated the need for such safeguards. The possibility of Nazi-type experiments
occurring in a civilized society was dismissed out of hand. In 1953 the British Medical Research
Council was the first to promulgate a statement on medical research ethics. This memorandum
called for a signed informed consent statement and an oversight body to guide researchers.
Parliament engaged the issue in 1955 after an experiment on the effects of two different penicillin
concentrations in infants was performed without parental consent. Nothing came of the Parliamentary
debate as the ministers did not consider it their duty to interfere with professionals in the
conduct of their responsibilities (Evans and Beck, 2002).
Russia conducted its own version of the Nuremberg Trials in 1949 in Khabarovsk in which members
of the Japanese military were indicted for “criminal and inhuman experimentation on live
human beings, participated in the villainous killing of people by conducting cruel experiments on
them, and were developing biological weapons for the mass destruction of peaceful populations”
(Kubar, 2001).
Public discussion on ethical standards occurred in Great Britain in 1964, concerned largely with
treatments of direct benefit to the patient and procedures having no direct benefit to the subject.
The use of controlled clinical trials also came in for comment, with general agreement that if the
trial included two procedures, participants should be asked for their “cooperation.” It was also
agreed that true consent was necessary if an experiment involved procedures of no direct benefit
to the participants. Physician researchers, however, still resisted the concept of informed consent.
The Royal college of Physicians published a 1967 report that questioned the advisability of giving
patients a complete explanation of the experiment or even asking their consent. Physicians in the
United States (in a 1975 report from the Department of Health and Social Security), clearly felt
that requiring informed consent of everyone would hinder or prevent research and thought that
2005 Symposium Proceedings Book 201