Nuremberg

Informed consent in human experimentation before the Nuremberg code

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7070.1445 (Published 07 December 1996) Cite this as: BMJ 1996;313:1445
  1. Jochen Vollmann, professora,
  2. Rolf Winau, director and professora
  1. a Institute of the History of Medicine, Free University of Berlin, 12203 Berlin
  1. Correspondence to: Professor Vollmann.
  • Accepted 28 October 1996

The issue of ethics with respect to medical experimentation in Germany during the 1930s and 1940s was crucial at the Nuremberg trials and related trials of doctors and public health officials. Those involved in horrible crimes attempted to excuse themselves by arguing that there were no explicit rules governing medical research on human beings in Germany during the period and that research practices in Germany were not different from those in allied countries. In this context the Nuremberg code of 1947 is generally regarded as the first document to set out ethical regulations in human experimentation based on informed consent. New research, however, indicates that ethical issues of informed consent in guidelines for human experimentation were recognised as early as the nineteenth century. These guidelines shed light on the still contentious issue of when the concepts of autonomy, informed consent, and therapeutic and non-therapeutic research first emerged. This issue assumes renewed importance in the context of current attempts to assess liability and responsibility for the abuse of people in various experiments conducted since the second world war in the United States, Canada, Russia, and other nations.

First Prussian directive on informed consent

The introduction of scientific and experimental methodology into clinical medicine in the nineteenth century brought with it an increased demand for experimentation on human subjects, particularly in bacteriology, immunology, and physiology. This research was done mainly on patients in hospital, often without their consent, under an “ethos of science and medical progress.” As a result of injury to some patients subjected to non-therapeutic research, however, controversy and public debate ensued about the ethics of human experimentation.1 2 3 4

In 1891 the Prussian minister of the interior issued a directive to all prisons that tuberculin for the treatment of tuberculosis “must in no case be used against the patient's will.”5 But the …

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