Self experimentation and the Nuremberg Code

The Nuremberg Code is the cornerstone of human experimentation law and ethics.1 Nonetheless, the suggested exception of self experimentation in its article 5 has never been persuasive: no experiment should be conducted if there is an a priori reason to believe that death or disabling injury will occur, except, perhaps, in experiments where the experimental physicians also serve as subjects⇓.

The judges should have stopped at the word “occur.” Why is the exception there, and is it justifiable to put the lives of others at risk because the investigator is willing to risk his or her own life? The answer is that the prosecution at Nuremberg (and apparently the judges as well) thought that this exception was necessary to prevent the Nazi doctors from arguing that previous US government military experiments—most notably the Walter Reed yellow fever experiment—had also knowingly risked the lives of subjects. This explanation is supported by the originally suggested wording of article 5 by each of the two principal doctors who worked for the prosecution at Nuremberg, Leo Alexander and Andrew Ivy. Alexander suggested adding yet another clause: “such as was done in the case of Walter Reed’s yellow fever experiments.”2 Ivy would have replaced the existing clause with: “except in such experiments as those …