Between 1945 and 1949, thirteen trials were held in Nuremberg, Germany. Their purpose was to bring Nazi war criminals to justice, and the defendants included Nazi officials and military officers, as well as doctors, businessmen, and lawyers, who were indicted on such charges as crimes against peace and crimes against humanity. In December 1946, twenty-three German physicians were charged with participating in war crimes and crimes against humanity for their part in euthanasia programs and for performing medical experiments on concentration camp inmates, most of whom either died or were permanently injured as a result. In the so-called Doctors Trial, judges confronted the complex ethical questions that surrounded medical experiments. Many of the defendants argued that there was not a specific international law preventing such experiments and that they were unaware of the difference between legal and illegal experimentation. American doctor Leo Alexander, who along with Dr. Andrew Ivy was assisting the prosecution, developed a framework for ethical medical experiments on human subjects that formed the basis of the Nuremberg Code.

Between 1945 and 1949, thirteen trials were held in Nuremberg, Germany. Their purpose was to bring Nazi war criminals to justice, and the defendants included Nazi officials and military officers, as well as doctors, businessmen, and lawyers, who were indicted on such charges as crimes against peace and crimes against humanity. In December 1946, twenty-three German physicians were charged with participating in war crimes and crimes against humanity for their part in euthanasia programs and for performing medical experiments on concentration camp inmates, most of whom either died or were permanently injured as a result. In the so-called Doctors Trial, judges confronted the complex ethical questions that surrounded medical experiments. Many of the defendants argued that there was not a specific international law preventing such experiments and that they were unaware of the difference between legal and illegal experimentation. American doctor Leo Alexander, who along with Dr. Andrew Ivy was assisting the prosecution, developed a framework for ethical medical experiments on human subjects that formed the basis of the Nuremberg Code.

The United States, the United Kingdom, France, and the Soviet Union established the International Military Tribunal (IMT) in Nuremberg, Germany, to prosecute “the major war criminals of the European Axis,” mostly senior Nazi political and military leaders. The trial before the IMT began in 1945. Twenty-four Nazi officials were indicted, and on October 16, 1946, ten of them were executed by hanging. Twelve more trials took place between 1946 and 1949 and are collectively known as the “subsequent Nuremberg trials.” These cases were tried not before the IMT, but before a US military tribunal, as growing disagreements among the Allies, particularly between the Soviet Union and the United States, had made further joint international trials impossible.

The first of these subsequent trials began on December 9, 1946, when twenty-three prominent German physicians and medical administrators were brought to trial before an American military tribunal. The defendants in the “Doctors Trial” were accused of war crimes and crimes against humanity for the murder and mutilation of hundreds of thousands of people—mostly Jews, Poles, Russians, and Romani (Gypsies). The accused fell into two broad categories. Some doctors had participated in euthanasia programs, which systematically murdered those considered undesirable by the Nazis, including those with physical and mental disabilities. The other principal accusation was against doctors who had performed medical experiments on concentration camp inmates without their consent. These experiments usually resulted in the death of the subject, or left them with lifelong physical impairments, and so were also a form of systematic murder.

The Doctors Trial lasted for 140 days, as the court considered nearly 1,500 documents and heard the testimony of eighty-five witnesses. On August 19, 1947, the tribunal paused before announcing its verdicts to consider the matter of ethical medical experimentation. Many of the accused doctors had claimed that there was no international law preventing human experiments and that their methods did not differ substantially from those of previous German and American experiments. Two American doctors, Andrew Ivy and Leo Alexander, who were working with the prosecution, had considered the ethical implications of human experiments, and Alexander had presented a draft of guidelines for legitimate research to the court in April. Alexander’s memo included six guidelines for ethical experiments. The court opinion, rendered on August 19, enlarged these guidelines to ten points, under the heading “Permissible Medical Experiments,” and it became known subsequently as the Nuremberg Code. This continues to be a cornerstone of medical ethics and has informed regulations governing experiments with human subjects ever since. Sixteen of the men accused in the Doctors Trials were found guilty, and seven were executed on June 2, 1948.

Leo Alexander was born in 1905 in Vienna, then part of the Austro-Hungarian Empire. He was the son of a Jewish physician and studied medicine at the University of Vienna and the University of Frankfurt. Alexander immigrated to the United States in 1933 and held positions at Worcester State Hospital, Boston City Hospital, Harvard Medical School, and Boston State Hospital before joining the faculty at Duke Medical School in 1941. Alexander worked as an Army medical investigator during World War II and was appointed chief medical officer to the US Council for War Crimes. He was a key advisor during the Nuremberg trials and helped to craft the Nuremberg Code, which established a widely accepted ethical framework for experimentation with human subjects. After the war, Alexander joined the faculty at Tufts University Medical School in Boston, where he taught for nearly thirty years. He worked with hospitals across the country to treat forty former concentration camp inmates who had been victims of Josef Mengele, the infamous Nazi physician at Auschwitz (who eluded capture and was thus not tried at Nuremberg). Alexander died in 1985 in Weston, Massachusetts.

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, over-reaching, 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 reasonable 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 and 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 problem 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.

The Nuremberg Code begins with the single most crucial element in ethical medical experimentation, and the thing that was most egregiously missing from the experiments performed in concentration camps: consent. Point one defines consent as voluntary permission without any coercion, from a person who is legally able to provide this consent. The person who is performing the experiment is responsible for making sure that the subject understands exactly the potential consequences of the experiment and cannot delegate this to another person. This voluntary consent is the most important of these points and the basis for all of the other points. In addition to voluntary consent, the experiment must be useful and necessary and conducted in such a way that there is a reasonable expectation that the results will be useful. Humans should only be used for experiments after preliminary animal experiments and other study, so the outcome can generally be predicted. Many of the experiments performed by the doctors on trial were not useful in the end because they were not conducted under appropriate conditions and could not be replicated. The betterment of humanity through science is paramount—only experiments whose risks are outweighed by the potential benefit to humanity should be conducted, and then only if the known risks do not include death or permanent damage.

Even with skilled practitioners, safeguards, and best intentions, experiments do sometimes go wrong, and the subject should be protected from harm, but also made aware of any potential consequences. The subject has the right to withdraw from an experiment at any time, and the scientist is obliged to end an experiment if it seems that injury will result. None of the points in the Nuremberg Code were followed by the doctors on trial, who caused permanent harm and even death, and did not have the permission of their subjects. This document lays out a framework within which future experiments can be conducted in an ethical manner.

In the aftermath of the unimaginable brutality of the Holocaust, the victorious powers in World War II worked diligently to ensure that war criminals were brought to justice. Those accused of war crimes often argued that they were just following orders, or that they had not violated any specific international laws that they could be tried under. Forced medical experiments on concentration camp prisoners fell into the second category, argued the defendants. The court decision in the Doctors Trial included the ten points that became known as the Nuremberg Code, which outlined ethical behavior for medical experiments. The essential theme in this document is the necessity of fully informed consent, and the steps that must taken for the reduction of harm to the subject of the experiment. None of the prisoners in concentration camps were given the chance to consent, and the experiments on them caused great harm, suffering, and often death. The Nuremberg Code established the ethical framework for all medical experiments involving human beings and has been used as a standard ever since.

• Annas, George J., & Michael A. Grodin.The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation. New York: Oxford UP, 1992. Print.
• “The Doctors Trial: The Medical Case of the Subsequent Nuremberg Proceedings.”Holocaust Encyclopedia. United States Holocaust Memorial Museum, 20 June 2014. Web. 27 Feb. 2015.
• Spitz, Vivien.Doctors from Hell: The Horrific Account of Nazi Experiments on Humans. Boulder: Sentient, 2005. Print.