It’s easy, in retrospect, to portray World War II as a major turning point in the history of medical ethics. But it’s a portrayal we should resist because it blinds us to the troubles that persist to this day in matters of informed consent.
When Germany surrendered in May 1945, the victors’ worst fears were confirmed: the Nazis had committed innumerable and horrific war crimes, including the attempt to annihilate the Jewish people. So severe were the depredations of Hitler and his henchmen and women that new words were invented to describe their actions: genocide (the obliteration of an entire people) and thanatology (the science of producing death).
As the extermination camps in Poland and the concentration camps in Germany were liberated, the scale of human destruction wrought by Nazi ideology both confounded and shocked. But, in their efforts to reap the benefits of Nazi scientific research, intelligence officers rapidly discovered the devastation of human medical experimentation.
Jews, political prisoners and other “undesirables” were subjected to a range of experiments that resulted in death and disability. The Luftwaffe, for instance, wished to know how to protect and revive pilots shot down in the sea who suffered from hypothermia.
The Nazi solution was to immerse experimental subjects in freezing water to the point of death and beyond.
Following the assassination of high-ranking Nazi Reinhard Heydrich, a cry went out to experiment more boldly with sulphanomides (drugs that curb the growth of bacteria) since Heydrich had died of wound infection.
The solution: scarify the legs of experimental subjects, infect the wounds and see what happens with or without drugs.
These examples are the tip of the iceberg. Experiments with transplants, bacteria, gases and other chemical agents were carried out on thousands of hapless prisoners. Worst of all was the T4 programme, which paved the way for the destruction of all “life unworthy of life” between 1939 and 1941. Thousands of disabled and mentally ill people were “euthanased” using a variety of techniques including mass gassing, a method that was later transferred to the extermination camps.
As part of trying to find out how Germany, one of the most scientifically sophisticated and humanistic cultures had become so perverted, a military tribunal was established as a corollary to the 13 Nuremberg trials. And between December 1946 and August 1947, 23 medical doctors were tried for war crimes and crimes against humanity.
The defence mounted by the doctors was founded on three points: first was the classic Nuremberg defence of only obeying orders in a time of national emergency. The second was that war was a time of national emergency where sacrifices had to be made for the greater good of the population, particularly troops.
But the most interesting was the final defence, which claimed what the Nazi doctors had done was little different from experiments carried out by the allies on their own prison populations, inmates of mental asylums, conscientious objectors and troops.
This final point was undeniable: in both the United States and Britain, experiments had been carried out on vulnerable groups. In 1941, for instance, patients at a Michigan state mental hospital were deliberately infected with the influenza virus. And in the early 1940s, predominantly African-American prisoners at the Statesville Penitentiary were deliberately infected with malaria.