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50th anniversary of the trial of Nazi doctors is occasion for re-evaluation of medical ethics

The 1946 Medical Trial at Nuremberg, in which Nazi doctors were convicted for acts of torture, barbarism and murder, held many lessons for the practice of medicine in the United States, a Cornell University scholar says.

But the tactics used by a renowned U.S. medical scientist to help prosecute the Nazi doctors bordered on perjury, argues Jon M. Harkness, Ph.D., visiting scholar in Cornell's Department of Science and Technology Studies. Harkness, who also is managing editor of ISIS, the Journal of the History of Science Society, writes in the Journal of the American Medical Association (JAMA, Nov. 27, 1996) on the occasion of the 50th anniversary of the Medical Trial at Nuremberg. His paper, "Nuremberg and Wartime Experiments on U.S. Prisoners," examines the response of the American prosecution team to an attempt by the German defendants to equate wartime medical experiments on American prisoners with experiments on Nazi concentration camp inmates. His paper is one of several that appear in the Nov. 27 JAMA about the trial.

"In no way do I condone or endorse what the Nazi physicians did," Harkness said. "I am only applying a critical examination to the prosecution's case."

In the Nuremberg Medical Trial, the defense tried to show that there was no difference between what the Nazi doctors did and what U.S. doctors did in Stateville Prison, Joliet, Ill., by experimenting with a malaria vaccine on prisoners.

In rebuttal, prosecutors summoned Andrew Ivy, a medical researcher and vice president of the University of Illinois at Chicago in charge of the medical school and its hospitals. Ivy, also appointed by the AMA as medical ethics consultant to the trial, asked Illinois Gov. Dwight Green to form an ad hoc committee to advise the governor on ethical considerations involved in medical experiments. But Ivy did not indicate to the governor that he was going to testify at Nuremberg, Harkness said.

That committee never met, yet Ivy went to Nuremberg and testified that the committee issued a report, known as the Green report. Ivy actually wrote the report alone, justifying the prison research and refusing to acknowledge any parallels to the Nazis. That report later was published in JAMA and was used as a basis in subsequent decades to justify medical research on U.S. prisoners, Harkness said.

The Green report refused to concede even a remote moral similarity between the experimental atrocities committed in Nazi concentration camps and the medical tests carried out in U.S. prisons during the war.

"Ivy's stance can be seen as a symptom of a broader refusal among U.S. medical scientists to draw lessons from their actions from the Nuremberg Medical Trial," Harkness writes. "But Andrew Ivy's posture was more than just representative; Ivy also helped to create this widespread attitude. His thoughts and deeds during the trial . . . contributed to a widespread failure among U.S. medical scientists to grapple with the difficult ethical questions about their own work that the Nuremberg Medical Trial might have raised. In effect, as Ivy assured the judges in Nuremberg that there was nothing ethically suspect about experimentation with prisoners in the U.S., he sent the same message to his U.S. colleagues."

Still, Harkness said, "The doctors would have been convicted even if the prosecution had not initiated this rebuttal to the claim that there was a parallel between the concentration camp experiments and experiments at Illinois. This was a trial on two levels: On one level, it was a straightforward case of brutal torture and murder. But the prosecution also was concerned to condemn these crimes as unethical human experiments. I think the reason they did that was the prosecution was concerned that human experiments in general not be characterized as torture and murder."

Harkness points out, however, that there were significant moral differences between the experiments in the concentration camps and in U.S. prisons. "In the U.S., there were attempts to get consent. The prisoners were not dragged out of their cells; they were not absolutely involuntary research subjects like the victims of the Nazi experiments. The other moral difference is that none of the experiments in this country were designed to end in the deaths of the subjects. Those are two highly significant differences," he said.

Many of Harkness's conclusions are based on material not available in the published, abridged Nuremberg trial records, which most other Nuremberg scholars have relied on almost exclusively. Instead, Harkness delved into the complete 10,000-page trial transcript, available on microfilm from the National Archives, as well as the collected papers of a Green Committee member maintained at a University of Chicago archive.

Harkness called Ivy a "master of the white lie" for not telling the governor why he wanted a committee and for conjuring up a committee report that only he wrote, but also for slyly answering questions about the committee on the stand to reflect only his viewpoint.

"The implications were serious and significant," Harkness said. "This rebuttal, this phantom committee report, ends up getting published in JAMA. There is absolutely no indication in that article, six months after the trial, that the committee was formed in reaction to a specific and harsh condemnation of the very research that the report claimed was morally and ethically ideal. Then, researchers and advocates of the use of American prisoners as research subjects, for the next few decades, would refer back to this blue ribbon panel justifying their work, yet the panel's report was a sham in the first place."

When medical experimentation on prisoners in the United States became controversial in the early 1970s, critics pointed to the Nuremberg code, which states that all medical experiments on humans must be voluntary. "These critics looked to this and said, 'Given the Nuremberg trial and code, how in the world could American researchers continue to use prisoners as research subjects?' The story I've uncovered is a large part of the answer: The Nuremberg Medical Trial produced something other than the code; in effect, it produced this article in JAMA, which proclaimed prison research as ethically ideal."

The committee did eventually meet, but after the trials. Harkness writes: "The final report altered each of the conclusions that Ivy had presented in Nuremberg in minor ways, but there is no evidence that anyone on the committee challenged the fundamental premise that the group was created to endorse: that prison research American-style was ethically acceptable. In fact, the final report of the committee judged the wartime research on Illinois prisoners as more than ethically acceptable. These experiments were cited by the group as 'an example of human experiments which were ideal because of their conformity' with the highest standards of human experimentation."