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Welcome to Cross Talk! I'm your host Sara Cross.

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This week we are going to go over some more history I have put together on the subject of World War II and The Nuremburg Code.

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So, let's get started and move into our main topic today.

"Now I am to become death, the destroyer of worlds."

- J. Robert Oppenheimer

What does World War II and the Nuremberg Code have to do with anything in regard to our current times?

Lets' find out, shall we?

The Nuremberg Code is a set of ethical principles that dictate how to avoid exploitation, experimentation and any other abuse against humanity. It was created by the court in U.S. v Brandt, one of the Subsequent Nuremberg trials that were held after the Second World War.

The origin of the Code began in pre–World War II German politics during the 1930s and 1940s. Starting in the mid-1920s, German physicians who were in favor of racial hygiene were being accused by the public and the medical society of unethical medical practices. The use of racial hygiene was supported by the German government in order to promote an Aryan race. Racial hygiene extremists merged with National Socialism to promote the use of biology to accomplish their goals of racial purity. Physicians were attracted to the scientific ideology and aided in the establishment of National Socialist Physicians' League in 1929.

For therapeutic purposes, the guidelines allowed administration without consent only in dire situations, but for non-therapeutic purposes any administration without consent was strictly forbidden. However, the guidelines from Weimar were negated by Adolf Hitler. By 1942, the Nazi party included more than 38,000 German physicians, who helped carry out medical programs such as the Sterilization Law.

Laws passed in this period included the Law for the Prevention of Hereditarily Diseased Offspring (passed on July 14th of 1933), which called for the compulsory sterilization of people with a range of hereditary, physical, and mental illnesses.

Under the Law against Dangerous Habitual Criminals (passed November the 24th of 1933), habitual criminals were forced to undergo sterilization as well. This law was also used to force the incarceration in prison or Nazi concentration camps of "social misfits" such as the chronically unemployed, prostitutes, beggars, alcoholics, homeless vagrants, black people and Romani (referred to as "Gypsies").

Rudolf Brandt was the defendant in the U.S. military trial that resulted in the Nuremberg Code. In response to the criticism of unethical human experimentation, the Weimar Republic (Germany's government from 1919 to 1933) issued "Guidelines for New Therapy and Human Experimentation". The guidelines were based on beneficence and non-maleficence, but also stressed legal doctrine of informed consent. The guidelines clearly distinguished the difference between therapeutic and non-therapeutic research.

After World War II, a series of trials were held to hold members of the Nazi party responsible for a multitude of war crimes including crimes against humanity. The trials were approved by President Harry Truman on May the 2nd of 1945 and were led by the United States, Great Britain, and the Soviet Union. They began on November the 20th of 1945 in Nuremberg, Germany in what became known as the Nuremberg trials.

In the trial of USA v. Brandt German physicians responsible for conducting unethical medical procedures on humans during the war were tried. They focused on physicians who conducted inhumane and unethical human experiments in concentration camps, in addition to those who were involved in over 3.5 million sterilizations of German citizens including the Jewish community, the physically and mentally disabled and people with family histories of alcohol or drug abuse.

Several of the accused argued that their experiments differed little from those used before the war, and that there was no law that differentiated between legal and illegal experiments. In April of 1947 Dr. Alexander submitted a memorandum to the United States Counsel for War Crimes outlining six points for legitimate medical research.

An early version of the Code known as the Memorandum, which stated explicit voluntary consent from patients are required for human experimentation was drafted on August the 9th of 1947. On August the 20th of 1947 the judges delivered their verdict against Karl Brandt and 22 others. The verdict reiterated the Memorandum's points and, in response to expert medical advisers for the prosecution, revised the original six points of the Memorandum to ten points.

The ten points became known as the Nuremberg Code, which includes such principles as informed consent and absence of coercion, properly formulated scientific experimentation, and beneficence towards experiment participants. It is thought to have been mainly based on the Hippocratic Oath, which was interpreted as endorsing the experimental approach to medicine while protecting the patient.

The Code was initially ignored and has not been officially accepted as law by any nation or as official ethics guidelines by any association. However, the Code is considered by some to be the most important document in the history of clinical research ethics, because of its massive influence on global human rights.

In the United States, the Code and the related Declaration of Helsinki influenced the drafting of regulations proclaimed by the United States Department of Health and Human Services to ensure ethical treatment of human research subjects which is now outlined in Part 46 of Title 45 of the Code of Federal Regulations. Article seven prohibits experiments conducted without the "free consent to medical or scientific experimentation" of the subject.

In 1995, Judge Sandra Beckwith ruled in the case In Re Cincinnati Radiation Litigation (874 F. Supp 1995) that the Nuremberg Code may be applied in criminal and civil litigation in the Federal Courts of the United States. In his 2014 review it was observed as the prototype for all future codes of ethical practice across the globe. Informed consent also served as the basis for the International Ethical Guidelines for Biomedical Research Involving Human Subjects.

The Nuremberg Code became a cornerstone of clinical research and bioethics.

From this you can figure out the Nuremberg Code was created out of the necessity to enforce human medical rights. Even though the Hippocratic Oath should have been enough for any practicing physician or scientist to uphold this basic human right. These two documents outline almost the same things it's just apparently people need to hear what the details. That people need to be explained the Oath's contents in the form of Man's Law is a mystery to me but maybe this is required for people to understand that no one has the right to enforce medical harm on others. Period.

The Nuremberg Code (1947)

1. The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion, and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision. This latter element requires that before the acceptance of an affirmative decision by the experimental subject there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person which may possibly come from his participation in the experiment. The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs or engages in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity.

2. The experiment should be such as to yield fruitful results for the good of society, unprocurable by other methods or means of study, and not random or unnecessary in nature.

3. The experiment should be so designed and based on the results of animal experimentation and a knowledge of the natural history of the disease or other problems under study that the anticipated results will justify the performance of the experiment.

4. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury.

5. No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur, except, perhaps, in those experiments where the experimental physicians also serve as subjects.

6. The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment.

7. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death.

8. The experiment should be conducted only by scientifically qualified persons. The highest degree of skill and care should be required through all stages of the experiment of those who conduct or engage in the experiment.

9. During the course of the experiment the human subject should be at liberty to bring the experiment to an end if he has reached the physical or mental state where continuation of the experiment seems to him to be impossible.

10. During the course of the experiment the scientist in charge must be prepared to terminate the experiment at any stage if he has probable cause to believe, in the exercise of the good faith, superior skill, and careful judgment required of him that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject.

These are the ten guidelines that outline basic principles that must be observed in order to satisfy moral, ethical and legal behavior in regard to medical and scientific advancement.

If you are a doctor, a scientist or a student of medicine and you have not read the Nuremberg Code go over it very carefully and take it all in. As you did for the Hippocratic Oath analyze each detail of the Code and ask yourself if you have violated any part of it.

If you have violated human medical rights, then my suggestion is to resign immediately and take the time to reflect on your behavior.

If you have read the Code in the past and have chosen to violate this Code than you have officially committed crimes against humanity and your privilege to be entrusted with human health is invalid.

If you are thinking about being a student of science and medicine than read through this Code and understand it in full before you make that leap to take on the obligation of human health and safety.

I repeat, the world needs its' doctors and scientists. Do not betray our trust.