Introduction

The Nazi plan to exterminate whole populations in Eastern Europe based on an ideology of racial superiority gave rise to the use of human experimentation on a prison population.1 The aim of this article is to explore the nature of human experimentation performed by the Nazi regime, the subsequent formation of the Nuremberg code and discuss the morality of the use of data from trials performed by Nazis.

Nazi experiments

Following the defeat of Germany in the second world war (WWII), the Nazis destroyed the majority of records regarding their unethical experiments. Most information is based on testimonies made by the perpetrators during their trials as well as the victims, who underwent medical examinations.2 The experiments can be categorised into two sections: state sponsored experiments that had applications to the military or for Nazi ideology, and those done out of scientific interest.3 Hitler’s regime sponsored Medico-Military Research under Heinrich Himmler’s direct orders of the conditions faced by the Luftwaffe, the German airforce.4 The principle type of experiment carried out at Dachau were for the benefit of the Luftwaffe.2Tests on the potability of sea water were tested on 90 Roma prisoners. The Dachau freezing experiments studied the survivability of the freezing conditions of the North Sea for pilots shot down.4   At Ravensbrück  Polish women had gas gangrene bacteria injected. The women were tested with new antibiotics and surgical procedures in an attempt to treat the inflicted infection.5 These procedures were to examine sulphonamide’s antimicrobial properties. The infection was further aggravated by having broken glass, sawdust and fabric rubbed into it and blood vessels either side of the infected wound constricted to reduce blood flow. This was done to stimulate the conditions of the battlefield. Initially the operations were performed in a sterile environment but as prisoners began to resist, operations were done forcibly in unsanitary conditions on wooden boards. Victims didn’t have their legs washed before and wore clothes during the operation.2 In Auschwitz, Dr Josef Mengele would isolate monozygotic twins, examine any physical or physiological defects, harvest any biological material of interested and inspect it. Due to their identical genetic composition, Mengele could eliminate any genetic factors for experiments, so would test the reaction of each twin to certain stimuli such as injections of pathogens. 6 The prevailing opinion amongst other doctors in Auschwitz was that Mengele’s aim was ‘to unlock the secret of multiplying the race of superior beings’. It was his desire to find out the genetic factors that cause twins to be able to replicate, implying his research was to advance Nazi ideology. 7 Substantial sterilisation and castration experiments were carried out by doctors Carl Clauberg and Horst Schumann, these experiments were encouraged by the state as a display of racial policy.3

Nazi Medicine and medical ethics

In the modern version of the Hippocratic oath, a doctor states that “I will respect the hard-won scientific gains of those physicians in whose steps I walk.” 8 This raises the question, should we follow the discoveries made by Nazi doctors. The modern Hippocratic oath makes no promise to “do no harm’ or never give a lethal medication, however it reminds the doctor that they have special obligations to fellow human beings, regardless of whether they are “sound of mind and body as well as the infirm”. 9The Doctors who carried out the experiments undisputedly violated the Hippocratic oath. Before claiming Nazis abandoned all ethics in the pursuit of science, a distinction must be made between no ethics and bad ethics.

Beneficial studies

The Nazis conducted the first study into tobacco-cancer epidemiology. A 1939 artilce by franz H.Muller and a 1943 paper by Eberhard Schairer and Erich Schöniger present convincing evidence that cigarettes were a major cause of lung cancer. Questionnaires were sent to families of lung cancer victims to determine whether they had smoked. Their conclusion: smoking was a very likely cause of lung cancer. A 1994 re-evaluation of the study showed the probability the results were down to chance was less than 1 in 10000000. The institution Schöniger and Schairer worked for received a RM 100,000 gift from Hitler himself, an avid anti-smoker. The link between nazi ideology and nazi medicine leads to issues with the citation of these studies as the reason for these studies was for the improvement of a hygienic aryan race.10

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Though Nazi medicine was innately racist, there was a culture of the importance of hygiene and obedience to legal authority. Even during the inhumane experiments, the Nazis never non-consensually experimented on ‘healthy’ German citizens and instead experimented on those whom they deemed less than human. Jews were considered a diseased race. Russian prisoners of wars were enemies of the state and the disabled who were regarded as useless to the work force. It is therefore necessary to not make Nazi doctors to be considered as morally devoid, as it would hold them unaccountable.10  

The data on how long a person could be submersed in freezing water and be resuscitated obtained by Dr Sigmund Rasher is considered the most potentially useful data obtained unethically during the Nazi regime. Rasher’s goal was to determine the amount of time a Luftwaffe pilot could survive in the north sea. In 1942 Rascher submerged 300 naked victims in freezing water, monitoring heart rate, muscle control and core temperature. He took note of when patients lost consciousness. Though more than 80 prisoners were killed some would argue that the data obtained is valuable and irreproducible, due to the uniqueness of the data some journals argue for its use, as it could never be done in an ethical environment. A number of medical journals have cited the research, as it played a role in the rediscovery of a warming technique for sufferers of hypothermia and for the development of survival suits for cold water. Few concentration camps had worthwhile pursuits. Mengele’s attempt to increase multiple births across the Ayran’s and research on how to perform mass sterilization would be of no use to modern moral doctors, even if the trails produced reliable data. Experiments that could have been useful, such as the testing of new antibiotics should not be cited for medical research, since it has been repeated elsewhere under humane conditions. These studies have more reliable and less controversial results.11  Aside from the complex moral issues that arise with the use of the data, even if the experiments carried out were accurate, the results could never be considered to be scientifically valid as the results are obtained from a malnourished prisoner population.12 Prisoners were weakened, malnourished and experimented on against their will, therefore their physiological response to the stimuli during experiments may be different to that of healthy patients. Data retrieved from these experiments were never replicated and should never be replicated to the same standard, so therefore the reliability of such experiments cannot be known. Conversely the lack of repeatability of these experiments could be considered as ground to use them, as such as the case with Rashers hypothermia experiments, the conditions used could never be used on consenting volunteers. 13In the 1980s Dr Robert Pozos, director of the hypothermia laboratory at the university made the argument to use the data from lifesaving research. Pozos was refused by the New England journal of medicine as even though the data may save some lives, it makes the victims our “retrospective guinea pigs, and we, their retrospective torturers’’.12

Allied human experimentation

An argument made by the defence of Nazi Doctors during the Nuremberg trials applies to the justification for the use of the data. Other countries have used human experimentation during WWII. American medical research carried out from 1941-1945 did not meet the standards used to try the Nazis. American investigators sponsored by the Office of scientific research and development violated the requirement for voluntary consent. Subjects unable to give consent, such as orphans, conscientious objectors and the mentally disabled were used to for the study of diseases such as dysentery, typhoid, hepatitis, malaria and influenza. If the results obtained from these experiments can be cited, then it follows that results from Nazi experiments could be used, as those who were experimented on, were no consenting subjects who belong to a marginalized group.5

Formation of the Nuremberg code

The immediate reaction to Nazi medical crimes was for the judges of the Nuremberg trials to set a catalogue of principles to protect vulnerable groups. The Nuremberg was the first international medical code. One could state that we should not use the experiments from Nazi trials because the standards to which modern human experimentation is based on was made to prevent such atrocities being carried out again. 1

The code states that the voluntary consent of the human subject is essential, that the experiment should yield fruitful results, that the experiment should be conducted to avoid unnecessary suffering. It states that there should be no risk of death to the subject, that adequate facilities should be used and that the subject should be at liberty to bring the experiment to the end. The Nazis went against all points of the code. Unwilling patients were forced into situations that resulted in many of their deaths. Though the code wasn’t formed until after their downfall, modern researchers should only cite data obtained from sources that follows a strict code when doing human experimentation.13

Despite the formation of these guidelines in 1947, illicit human experimentation still exists. From the mid 1950s to early 1970s during which researchers at New York university infected retarded children with hepatitis to track the course of the disease. Though this case doesn’t seem as extreme as Nazi experiments, if researchers’ credit these then it could lead to the encouragement of more unethical studies. To the same extent, the use of Nazi data could encourage the use of immoral studies against those who cannot consent 14

Conclusion- Should we use results from NAZI experiments?

Nazi experiments were a hideous crime against, for which many of the perpetrators were sentenced to death. The suffering of the victims acts a reason enough for many to avoid the use of the tainted data. 5The data was largely obtained as part of a racially motivated regime’s attempts to further their cause. The trials led to the formation of an international code on the ethic of human experimentation, which scientists should now abide by.5 The fact remains however, that there are some benefits to the use of such data. The Nazis were the first to discover the link between tobacco and cancer, the studies made have been cited recently and have been evaluated and are considered accurate. 10The hypothermia experiments have been used by medical journals and are considered useful, as some experiments can never be recreated in an ethical environment.12

It is difficult for one to ultimately decide on whether Nazi data should be consulted. The availability of other ethical data and whether the data is credible should always be taken into account before Nazi data is considered.

References:

Schmidt U. Chapter 54: Medical Ethics and Nazism. Baker R (Ed). The Cambridge World History of Medical Ethics. Cambridge; Cambridge University Press: 2009:595-608

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Lifton R. Chapter 15:The experimental Impulse. The Nazi Doctors: Medical killing and the psychology of Genocide,2e. London; Papermac: 1990:269-302

https://www.jewishvirtuallibrary.org/the-ethics-of-using-medical-data-from-nazi-experiments#nazi accessed:14.10.2018

Lederer S. Chapter 49: The ethics of Experimenting on Human subjects. Baker R (Ed). The Cambridge World History of Medical Ethics. Cambridge; Cambridge University Press: 2009:595-608

Müller-Hill B. Genetics of susceptibility to tuberculosis: Mengele’s experiments in Auschwitz. Nature Reviews Genetics. 2001;2:631-634.

Lifton R. Chapter 17:Dr.Auschwitz: Josef Mengele. The Nazi Doctors: Medical killing and the psychology of Genocide,2e. London; Papermac:1990:269-302

https://hslmcmaster.libguides.com/c.php?g=306726&p=2044095 accessed 24.10.2018

 Hajar R. The physician’s oath: Historical perspectives. Heart Views. 2017;18:154.

Proctor R. Nazi Science and Nazi Medical Ethics: Some Myths and Misconceptions. Perspectives in Biology and Medicine. 2000;43:335-346.

https://slate.com/news-and-politics/2010/06/do-doctors-use-nazi-data-in-their-research.html accessed 24.10.18

Bogod D. The Nazi Hypothermia Experiments: Forbidden Data?. Anaesthesia. 2004;59:1155-1156.

The Nuremberg Code (1947). BMJ. 1996;313:1448-1448.

https://www.pbs.org/wgbh/nova/holocaust/experifull.html accessed 27.10.18