The Doctors’ Trial and the Nuremberg Code
Charleston, West Virginia, United States
|“Dachau Concentration Camp workers.” Photo by Dale Cruse on Flickr. CC BY 2.0.|
Tracing back to the Hippocratic Oath, which dates to around 400 BC, the principle of autonomy has been fundamental to the concept of informed consent.1,2 The Oath, a pledge historically taken by physicians, outlines several guarding principles of medical ethics. Although it did not specifically mention informed consent, it revolves around the phrase “primum non nocere,” which translates to “above all, do no harm.” Over time, the Hippocratic Oath has been revised to reflect changes in values and attitudes. However, it continues to serve as a blueprint for medical ethics. Unfortunately, the principle of informed consent was not widely accepted until recent times.
The Nuremberg Code, a set of ten research principles for human experimentation, emerged as a consequence of the Nuremberg Trials in 1945.3,4 Established as an outcome of United States of America v. Karl Brandt, et al., also known as the Doctors’ Trial, the first of twelve US military tribunals for war crimes committed during World War II, the Code’s origin was one of the darkest moments in the history of medicine.
Although the term “racial hygiene” (rassenhygiene) was introduced by Alfred Ploetz in his book Racial Hygiene Basics (Grundlinien einer Rassenhygiene), it was not until the 1920s that this ideology was adopted heavily in Germany.5 Racial hygiene aimed to improve the quality of the population by selective breeding and prevention of procreation in those who were deemed “unfit” and carried undesirable traits. The top German racial hygienists at that time believed that many characteristics and attributes were inherited; thus, by controlling reproduction, they could eliminate unwanted illnesses and improve and encourage desirable traits.
|“Dachau Concentration Camp autopsy.” Photo by Dale Cruse on Flickr. CC BY 2.0.|
The Law for the Prevention of Genetically Diseased Offspring (Gesetz zur Verhütung erbkranken Nachwuchses), also known as the Eugenics Law or Sterilization Law, was enacted in July 1933, shortly after the Nazi party came to power. The goal was to prevent reproduction in people who suffered from congenital mental deficiency, schizophrenia, manic-depressive insanity, hereditary epilepsy, hereditary chorea (Huntington’s Disease), hereditary blindness, hereditary deafness, any severe hereditary deformity, and severe alcoholism.7 The Genetic Health Courts (Erbgesundheitsgericht, EGG), which consisted of a judge, a medical officer, and a medical practitioner, was given the power to make these decisions “at its own discretion after considering the results of the whole proceedings and the evidence tendered.”8 In practice, however, the physician alone rendered such judgment and only involved the judge to ensure that legal obligations were met.8
In 1934, the first year of the law’s enactment, some 84,600 cases were presented before the Genetic Health Courts, resulting in the forced sterilization of 62,400 individuals.9 Defendants could appeal the decision to the Higher Genetic Health Court (Erbgesundheitsobergericht, EGOG), but out of nearly 4,000 such appeals, only 441 were granted.9 The following year, there were 88,100 trials and 71,700 individuals sterilized.9 In total, around 400,000 people were sterilized involuntarily under this law.
The Eugenics Law paved the way for the state to take away individuals’ autonomy and created a pathway for future medical atrocities in concentration camps. It represented a significant step towards more extreme action, policy, and human experimentation. Furthermore, it is one of the key factors that led to the development of the Nuremberg Code, as it highlighted the importance of protecting the rights and welfare of individuals in medical research.
After World War II, the Allied powers—the United States, the United Kingdom, the Soviet Union, and France—established a tribunal to hold the leaders of the Nazi regime accountable for war crimes and crimes against humanity. This tribunal, referred to as the International Military Tribunal, took place in Nuremberg, Germany from November 1945 to October 1946.
In addition to the International Military Tribunal, other trials in Nuremberg focused on prosecuting lower-ranking Nazi officials. In the first of these trials, United States of America v. Karl Brandt, et al., twenty of twenty-three defendants were medical doctors who stood accused of unethical human experimentation and involuntary mass sterilization. The Nuremberg Code was issued as a result of this trial and is considered to be a landmark in the history of medical ethics. Its ten-point agenda aims to protect human rights in medical experimentation, served as a foundation for the Declaration of Helsinki, and has become a foundational document in research involving human subjects.10
The legacy of these experiments is still felt today, both in the physical and psychological scars left on survivors, and in the broader ethical debate around medical research. These dark moments in history serve as a stark reminder of the dangers of unchecked power. Even those who have taken an oath to prioritize the well-being of their patients can become corrupted by ideology and a desire for scientific advancement at any cost. As physicians and medical communities continue to advance medical knowledge and technologies, it is essential that we uphold the primum non nocere principle and maintain the trust and confidence of our patients. It is our responsibility as a society to always strive to use our knowledge and expertise for the betterment of humanity, not its destruction.
- Jones WHS. “The Hippocratic Oath – Ludwig Edelstein: The Hippocratic Oath. Text, Translation, and Interpretation. Pp. vii+64. Baltimore: Johns Hopkins Press, 1943. Paper, $1.25.” The Classical Review. Cambridge University Press; 1945;59(1):14-5.
- Jouanna J, Van Der Eijk PJ (editor). Hippocrates (translated by M. B. DeBevoise). Baltimore and London: The Johns Hopkins University Press; 1999.
- US Library of Congress. Nuremberg Tribunal Indictments. Internet Archive. Accessed March 11, 2023. https://web.archive.org/web/20090329134633/http://www.loc.gov/rr/frd/Military_Law/pdf/NT_Indictments.pdf.
- Permissible Medical Experiments. Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10: Nuremberg October 1946–April 1949. Washington: U.S. Government Printing Office (n.d.), vol. 2, pp. 181-182.
- Ploetz, A. Grundlinien einer Rassenhygiene. Band I, Die Tuechtigkeit unserer Rasse und der Schutz der Schwachen. Berlin: S. Fischer; 1895.
- Turner HA. IBM and the Holocaust: The Strategic Alliance between Nazi Germany and America’s Most Powerful Corporation. New York: Crown; 2001.
- The law for the prevention of hereditarily diseased offspring. Berlin: Reichsdruckerei; 1935.
- Foth T. Caring and Killing: Nursing and Psychiatric Practice in Germany, 1931-1943. V&R Academic; 2013.
- Friendlander H. Chapter 2: Excluding the Handicap. In: Friendlander H, The Origins of Nazi Genocide: From Euthanasia to the Final Solution. Chapel Hill: University of North Carolina Press; 1995:28-37.
- Hurren, E. Patients’ rights: from Alder Hey to the Nuremberg Code. History & Policy. United Kingdom: History & Policy. Accessed on March 11, 2023. https://web.archive.org/web/20131207022621/http://www.historyandpolicy.org/papers/policy-paper-03.html.
SHABRINA JARRELL is a rising fourth-year medical student at West Virginia University School of Medicine – Charleston Division. Hailing from Indonesia, she finds solace in writing as a means to enhance her English skills and unlock a world of imagination. She has a deep fascination in cultural and traditional practices in medicine from around the world. In her free time, she finds pleasure in nature photography and practicing archery.
Submitted for the 2022–23 Medical Student Essay Contest
Spring 2023 | Sections | History Essays