The
atrocities of Nazi medicine, as well as the conditions that made them
possible, are even today a topic of heated debates among historians and
bioethicists. Proponents of various positions often refer to the Nazi
period in discussion of the ethics of research on human subjects. The
Nuremberg Medical Trial of 1946–47 and the ensuing Nuremberg Code
addressed in particular the absence of consent of those involved in
research in Nazi experiments, and as a consequence formulated the
principle of informed consent for the first time on an international
level. In addition to this crucial issue, the preconditions and inherent
rationale of Nazi biomedical science have been at the centre of
debates. Recent historical research documents both similarities and
differences between Nazi medicine and medicine in the other countries in
the developed world. It also suggests implications relevant for today's
debates on the ethics of research involving human beings.
Two
features of the Nazi period are crucial for understanding the specific
forms of research on human beings undertaken then: the totalitarian
political system and the broader paradigm of racial hygiene, which was
not solely the result of the Nazi political system, but rather a social
movement that drew on concepts created by understandings of contemporary
biology. Its origins precede the beginnings of the Nazi party by more
than two decades. But the autocratic political system and the programme
of racial hygiene reinforced each other and contributed to specific
questions to be addressed by the medical sciences, and to a setting in
which no ethical or legal regulations existed. This combination of
factors created the conditions for research to be undertaken that would
not otherwise have been possible.
Rassenhygiene
(a German equivalent for eugenics) was perceived as an applied science
founded on the laws of genetics, and as essential for improving the
health of the Volk, or race. It was thought to provide
long-term preventive measures against defects in the human genetic
material, complementing individual hygiene. Central to racial hygiene
was biological determinism: the view that humans live and behave as they
do by virtue of their biological constitution, and, ultimately, their
genes.
During the 1920s, many racial
hygienists were sympathetic to the Nazi movement when it gathered
strength, although similar eugenic aims were pursued by scientists,
physicians, lawyers, and politicians across the political spectrum, and
in the international scientific community. After the Nazi takeover in
1933, medical scientists, particularly geneticists, expected improved
conditions in various research endeavours. Many in the discipline, such
as Fritz Lenz and Ernst Rüdin, hoped to see the practical application of
the results of their scientific work, thereby contributing to
rebuilding society according to the laws of biology. They also hoped to
gain access to further resources to extend their research programmes.
State and party institutions, in turn, were seeking scientific
legitimation for their health and racial policies, such as the newly
implemented sterilisation law “for the prevention of genetically
diseased offspring”. The law allowed the forced sterilisation of those
who supposedly had genetically determined disorders. Along with the
later Law for the Protection of German Blood and German Honor, which
purported the “racial inferiority” of Jews, considerable minorities of
the population were defined as being “biologically” of minor value, with
the implication that they lost most or all of their civil rights, and
were easily available as “research material”.
In
the realm of science policy, resources were diverted mainly towards
research aimed at improving the health and performance of the Volk.
As a result, questions about heredity and fitness for occupational or
military service became central to most research programmes. There is no
indication that scientists were forced to do such research, or to do it
in the specific way outlined below. The cases that follow are selected
examples only.
Resources for genetic
research had increased considerably since the mid-1920s, with a further
boost from 1933 onwards. As a result, more and more scientists framed
their research projects in terms of genetics, and claimed that their
work could contribute to establishing criteria that differentiated
inherited diseases from acquired diseases. The experiments carried out
by Josef Mengele in the Auschwitz concentration camp were among the most
radical demonstrations of genetic-research interests in these contexts.
His investigations addressed questions such as the genetics of specific
proteins protecting against infections, or the heredity of eye colour.
Mengele correlated experimental data gained from examination of living
people (especially twins), with pathoanatomical and biochemical analyses
done after they had been killed. Tissue samples were sent to the Kaiser
Wilhelm Institute for Anthropology, Human Genetics, and Eugenics in
Berlin. Its director, Otmar von Verschuer, received funding for some of
these activities from the prestigious Deutsche Forschungsgemeinschaft.
Verschuer was an internationally recognised scientist, who, after World
War II, was appointed professor of human genetics at the University of
Münster. These details confirm that parts of Mengele's research
questions and methods conformed to the scientific logic of its time.
However, in a context of unlimited access to unconsenting people who
were defined as “biologically inferior”, the research programme was
accompanied by complete disregard for the victims, and many cruelties
ensued.
Within the German army and
the Nazi SS organisation, there were controversies over whether adding
antibiotics or homoeopathic drugs to traditional surgery would improve
wounded soldiers' chances of survival. By contrast, within the Allied
armies, this question had already been settled in favour of antibiotic
therapy. SS physicians organised trials of antibiotic and homoeopathic
treatments in the concentration camps at Dachau and Ravensbrück. Healthy
prisoners were given injections from the festering tissues of other
inmates who had wound infections. In some people, small pieces of wood
and glass were placed in open wounds, in order to mimic war injuries
more realistically. The victims were then treated with homoeopathic
preparations or various applications of sulfonamides; some received no
therapy at all. About a third of the victims died. All these experiments
followed a scientific logic that was outdated at the time, and which
took no account whatever of the wellbeing of those involved in research.
The surviving victims had irreversible physical damage and severe
psychological trauma.
Experiments in
the context of aviation medicine were aimed at finding methods to help
pilots survive after their planes had been hit at very high altitudes,
or after an emergency landing at sea. The experiments, carried out in
the Dachau concentration camp, focused on physiological questions, such
as the effects on the human body of low pressure at high altitude, or of
drinking salt water. The researchers responsible, such as Siegfried
Ruff, Sigmund Rascher, and Georg Weltz, were all associated with
university institutes or the German Air Force. For the high-altitude
experiments, about 200 people were chosen from the camp prisoners, at
least 70 of whom died during the experiments in a specially designed
low-pressure cabin, or were killed afterwards to study the pathological
changes in their brains. Judged strictly on scientific terms, the
methods and results of some of these experiments were apparently
innovative and useful. The US Air Force continued some of this research
after the war and published the results in cooperation with a number of
German physicians involved in the original experiments.
By
contrast to historical narratives postulating the irrationality of Nazi
science, it must be noted that medical research programmes in this
political context pursued questions that were in some cases outdated,
but which in other cases were in line with the prevailing standards of
the international scientific community. The methods and techniques used
also represented a broad range, from the conventional, even obsolete, to
the innovative. In most cases, the practical implementation of these
methods and techniques was brutal and showed total disregard for the
suffering of the individuals concerned.
The
existing evidence illustrates an inherent logic of these research
endeavours: the urge to establish new knowledge superseded any respect
for the people who suffered in these experiments. Faced with the
challenge of a given medical question, researchers sought opportunities
to carry out the experiments required to solve it. It was in
concentration camps, asylums, and hospitals in the occupied territories
that they found these opportunities because existing legal regulations
and sanctions did not apply there.
In
the context of the post-war Nuremberg Medical Trial, some of the
protagonists of these medical atrocities formulated ethical arguments to
justify their activities. The high value of gaining new scientific
knowledge and the importance ascribed to the health and wellbeing of
society as a whole, or the Volkskörper, were the central arguments placed above any regard for the suffering person.
The
historical experience strongly suggests the necessity of setting clear
limits on research involving human beings. These limits should be
defined with full respect for the participant's integrity and interests,
and in accordance with the best available medical knowledge. The
impetus to produce new knowledge, and the interests of society, or of
potential future patients, are legitimate considerations, but these must
not take priority over the research subject's free will and wellbeing.
Finally, such regulations should be linked to forceful sanctions in case
of violation. The debates surrounding the formulation, and the later
revisions of the Declaration of Helsinki amply document the difficulties
in implementing such regulations. Their practical application remains a
constant challenge.
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