Nazi human experimentation

Josef Mengele, the Angel of Death, who performed deadly experiments on prisoners at the Auschwitz concentration camp

Nazi human experimentation, in the context of this article, refers to the human subject research conducted by Nazi physicians, researchers, and their assistants on men, women, and children who did not volunteer or consent for the generally inhumane and brutal procedures to which they were subjected. This includes the experiments conducted on prisoners in Nazi concentration camps in the early to mid 1940s, during World War II and the Holocaust. Typically, the experiments were conducted without anesthesia and resulted in death, trauma, disfigurement, or permanent disability, and as such are considered examples of medical torture. This article is limited to human subject research and does not include the non-research-based activities of Nazi physicians in the sterilization and genocide of those deemed undesirable by the State on the basis of ethnicity or disability.

The Nazi human experiments included such atrocities as amputation and removal of body parts without anesthesia, deliberate infection with disease, exposure to extreme cold or low pressure, sewing of twins together, injection of substances into eyes, infliction of chemical burns, forced dehydration, and administering of poisons. Along with the horrifying war crimes committed by Unit 731 (the biological and chemical warfare unit of the Imperial Japanese Army), the Nazi human experiments represented one of the most notorious chapters in human subject research. After World War II, many of the Nazi physicians were tried in the particular Nuremberg Trial known as the Doctors' Trial. The Nuremberg Code is a set of fundamental ethical standards for human subject research that were released as part of the judges' decision in August 1947.

Given the horrific nature of the experiments, one issue that remains is whether or not one can ethically justify the present-day use of the results of those experiments.

Historical overview

Nazi Germany, or the Third Reich, officially known as the German Reich from 1933 until 1943 and the Greater German Reich from 1943 to 1945, was the state between 1933 and 1945 when Adolf Hitler and the Nazi Party controlled the country, transforming it into a dictatorship. Under Hitler's rule, Germany quickly became a totalitarian state where nearly all aspects of life were controlled by the government. The term Third Reich, meaning "Third Realm" or "Third Empire," alluded to the Nazis' conceit that Nazi Germany was the successor to the earlier Holy Roman Empire (800–1806) and German Empire (1871–1918). The Third Reich, which Hitler and the Nazis referred to as the Thousand Year Reich, ended in May 1945 when the Allies defeated Germany, ending World War II in Europe.

Racism, Nazi eugenics, and antisemitism were central ideological features of the regime. The Germanic peoples were considered by the Nazis to be the master race, the purest branch of the Aryan race. Discrimination and the persecution of Jews and Romani people began in earnest after the seizure of power. The first Nazi concentration camps were established in March 1933. Jews and others deemed undesirable or who opposed Hitler's rule were imprisoned, killed, or exiled. More than 1,000 concentration camps (including subcamps) were established during the history of Nazi Germany and around 1.65 million people were registered prisoners in the camps at one point. Around a million died during their imprisonment.

Prior to the advent of Nazism, there were informal and formal codes of ethics relative to German medical research. An example of the former were the German medical researchers who performed their experiments on themselves or on their own children prior to using others as subjects. An example of the latter was the Reich Circular on Human Experimentation of February 28, 1931, which included such regulations as the provision that "experimentation involving children or young persons under 18 years of age shall be prohibited if it in any ways endangers the child or young person" and "innovative therapy may be carried out only after the subject or his legal representative has unambiguously consented to the procedure in light of relevant information provided in advance" (Weindling 2011).

Some of the history of standards in Germany relative to informed consent are presented below in the section on Standards of ethics relative to German medical research: pre- and post-.

However, even with such codes, many unethical medical experiments continued to be conducted in pre-Nazi Germany, including experimentation in orphanages and prisons and Hans Eppinger's "invasive research without consent on parties in public wards in Vienna in the 1930s" (Weindling 2011).

After the Nazis came to power in 1933, Jewish doctors began to be purged from hospitals, universities, and public health positions and in 1938 were delicensed.

The advent of Nazi Germany led to many German physicians and their associates advancing a "race-based program of public health and genocide," unethical medical experiments "to advance medical and racial science," and inflicting 'unparalleled medical atrocities" (Weindling 2011). In his summary of "The Nazi Medical Experiments," Weindling (2011) noted that "physicians and medical and biological researchers took a central role in the implementation of the Holocaust and exploited imprisonment, ghettoization, and killings as opportunities for research," and demanded that "mental and physical disabilities be eradicated from the German/Aryan/Nordic race by compulsory sterilization, euthanasia, and segregation."

Inhumane medical experiments were conducted on large numbers of prisoners, including children, by Nazi Germany in its concentration camps in the early to mid 1940s, during World War II and the Holocaust. Chief target populations included Romani, Sinti, ethnic Poles, Soviet POWs, disabled Germans, and Jews from across Europe. In addition, physicians provided support for mass killings in the concentration camps by undertaking selections as to whom would be sent to the gas chambers. Nazi physicians and their assistants forced concentration camp prisoners into participating in the medical experiments; they did not willingly volunteer and no consent was given for the procedures.

At Auschwitz and other camps, under the direction of Eduard Wirths, selected inmates were subjected to various experiments that were designed to help German military personnel in combat situations, develop new weapons, aid in the recovery of military personnel who had been injured, and to advance the Nazi racial ideology and eugenics (United States Holocaust Memorial Museum 2006), including the twin experiments of Josef Mengele (Wachsmann 2015).

After World War II, a series of trials were held in Nuremberg, Germany for individuals being charged as war criminals. The best known of these is the one held for major war criminals before the International Military Tribunal (IMT). However, the physicians who engaged in the notorious human experimentation were also subject to a trial, known as the “Doctors’ Trial.” This was held before an American military tribunal (U.S. Nuremberg Military Tribunal or NMT) under Control Council Law No. 10. The Doctors’ Trial involved twenty-three defendants, most of whom were medical doctors and were being accused of criminal human experimentation. The trial began on December 9, 1946, and concluded on August 20, 1947.

One of the issues before the tribunal was what constituted acceptable medical experimentation involving human subjects. Some of the Nazi doctors argued that their experiments differed little from those conducted by American and German researchers in the past, and that there was no international law or even informal statements that differentiated illegal from legal human experimentation. For this reason, there was a need for the prosecution to demonstrate how the defendants' experiments had deviated from fundamental ethical principles that should govern research in civilized society. This led to the creation of the Nuremberg Code, which was issued as part of the verdict issued in August 1947.

After the Nuremberg Trials, unethical research with human subjects continued to be conducted. To some extent, many researchers assumed that the Nuremberg Code was specific to the Nazi trials and thus were not applied to human subject research in general. In addition, even in the Doctors' Trial, "remarkably none of the specific findings against Brandt and his codefendants mentioned the code. Thus the legal force of the document was not well established" and "failed to find a place in either the American or German national law codes" (United States Holocaust Memorial Museum).

However, the Nuremberg Code did find great relevance in being a source for many subsequent codes of ethics for human subject research. The standards enumerated in the Nuremberg Code ended up being "incorporated into most subsequent ethical codes—such as the Declaration of Helsinki—and in [United States] federal research regulations" (Amdur and Bankert 2022). As noted by Amdur and Bankert (2022):

The basic elements of the Nuremberg Code are the requirement for:

• voluntary and informed consent,
• a favorable risk/benefit analysis, and
• the right to withdraw without penalty

Experiments

The Harvard Law School Library's Nuremberg Trials Project has catalogued a wide varied of documents from the Nuremberg Trials. One document, labeled "Table of contents for prosecution Document Book 8, concerning medical experiments" includes titles of sections that document medical experiments revolving around food, seawater, epidemic jaundice, sulfanilamide, blood coagulation, and phlegmon (NMT Prosecution 1947a). Others include one titled "List of prosecution documents in Document Book 4, on malaria experiments" (NMT Prosecution 1947b) and one titled "List of documents in Document Book 2: High altitude experiments" (NMT Prosecution 1947c), as well as others dealing with poison gas experiments.

The United States Holocaust Memorial Museum (2006), in an article titled "Nazi Medical Experiments," classifies the medical experiments into three categories: (1) Experiments dealing with the survival of military personnel (such as high-altitude and freezing experiments on prisoners, and experiments related to drinking seawater); (2) Experiments to test drugs and treatments (such as bone-grafting, exposure to phosgene and mustard gas to test antidotes, exposure to various infections diseases, such as malaria and typhus, to test treatments, and testing with sulfanilamide drugs); and (3) experiments to test Nazi racial and ideological goals (Mengele's experiments on twins, sterilization experiments, testing of the ability of different groups to withstand contagious diseases, etc.)

The following present an overview of some of the Nazi human experiments conducted without subjects' consent or medical safeguards.

Experiments on twins

Experiments on twin children in concentration camps was under the central leadership of Josef Mengele. Josef Mengele (1911-1979) was a German Schutzstaffel (SS) officer and physician during World War II. He is mainly remembered for his actions at the Auschwitz concentration camp, where he performed deadly experiments on prisoners, and was a member of the team of doctors who selected victims to be killed in the gas chambers and was one of the doctors who administered the gas. Before the war, Mengele had received doctorates in anthropology and medicine, and began a career as a researcher. He joined the Nazi Party in 1937 and the SS in 1938. He was assigned as a battalion medical officer at the start of World War II, then transferred to the Nazi concentration camps service in early 1943 and assigned to Auschwitz, where he saw the opportunity to conduct genetic research on human subjects.

Mengele used Auschwitz as an opportunity to continue his anthropological studies and research into heredity, using inmates for human experimentation. His medical procedures showed no consideration for the victims' health, safety, or physical and emotional suffering (Kubica 1998). He was particularly interested in identical twins, people with heterochromia iridum (eyes of two different colors), those with dwarfism, and people with physical abnormalities (Kubica 1998).

From 1943 to 1944, Mengele performed experiments on nearly 1,500 sets of imprisoned twins at Auschwitz. The twin research was in part intended to prove the supremacy of heredity over environment and thus strengthen the Nazi premise of the genetic superiority of the Aryan race (Steinbacher 2005). Dr. Miklós Nyiszli (a Hungarian Jewish pathologist) and others reported that the twin studies may also have been motivated by an intention to increase the reproduction rate of the German race by improving the chances of racially desirable people having twins (Lifton 1986).

The experiments he performed on twins included unnecessary amputation of limbs, injecting dyes into their eyes to change their color, intentionally infecting one twin with typhus or some other disease, and transfusing the blood of one twin into the other. Many of the victims died while undergoing these procedures (Posner and Ware 1986) and those who survived the experiments were sometimes killed and their bodies dissected once Mengele had no further use for them (Lifton 1986). Nyiszli recalled one occasion on which Mengele personally killed fourteen twins in one night by injecting their hearts with chloroform (Lifton 1985). Often, one twin would be forced to undergo experimentation, while the other was kept as a control. If the experimentation reached the point of death, the second twin would be brought in to be killed at the same time. Doctors would then look at the effects of experimentation and compare both bodies, to allow comparative post-mortem reports to be produced for research purposes (Baron 2001; Lifton 1986). Witness Vera Alexander described how Mengele sewed two Romani twins together, back to back, in a crude attempt to create conjoined twins (Posner and Ware 1986); both children died of gangrene after several days of suffering (Mozes-Kor 1992).

Bone, muscle, and nerve transplantation experiments

From about September 1942 to about December 1943, experiments were conducted at the Ravensbrück concentration camp, for the benefit of the German Armed Forces, to study bone, muscle, and nerve regeneration, and bone transplantation from one person to another. In these experiments, subjects had their bones, muscles, and nerves removed without anesthesia. As a result of these operations, many victims suffered intense agony, mutilation, and permanent disability (Perper and Cina 2010).

On August 12, 1946, a survivor named Jadwiga Kamińska gave a deposition about her time at Ravensbrück concentration camp and describes how she was operated on twice. Both operations involved one of her legs and although she never describes having any knowledge as to what exactly the procedure was, she explains that both times she was in extreme pain and developed a fever post surgery, but was given little to no aftercare. Kamińska describes being told that she had been operated on simply because she was a "young girl and a Polish patriot." She describes how her leg oozed pus for months after the operations (NMT Prosecution 1947d; University of Toronto).

Prisoners were also experimented on by having their bone marrow injected with bacteria to study the effectiveness of new drugs being developed for use in the battle fields. Those who survived remained permanently disfigured.

The following is a fragment from the 1958 Medical Statement issued Dr. Hanna Dworakowska (University of Toronto):

The criminal experiments consisted in the deliberate cutting out and infection of bones and muscles of the legs with virulent bacteria, the cutting out of nerves, the introducing into the tissues of virulent substances and the causing of artificial bone fractures. The experiments were conducted in conditions of utter disregard for the basic principles of asepsis. After all operations, the victim was left to her own fate and was in most cases exposed to harmful factors hampering self-defense by the organism. Some victims died in consequence of the operation itself or of the resulting complications and several were shot, while the survivors suffered major and extensive injuries to their organs of movement.

Head injury experiments

In mid-1942 in Baranowicze, occupied Poland, a notorious experiment was conducted in a small building behind the private home occupied by a known Nazi SD Security Service officer, in which "a young boy of eleven or twelve [was] strapped to a chair so he could not move. Above him was a mechanized hammer that every few seconds came down upon his head." The boy was driven insane from the torture (Small and Shayne 2009).

Freezing experiments

A cold water immersion experiment at Dachau concentration camp presided over by Ernst Holzlöhner (left) and Sigmund Rascher (right). The subject is wearing an experimental Luftwaffe garment. In 1941, the Luftwaffe conducted experiments with the intent of discovering means to prevent and treat hypothermia. There were 360 to 400 experiments and 280 to 300 victims, indicating some victims suffered more than one experiment (Berger 1990).

Beginning in August 1942, at the Dachau camp, prisoners were forced to sit in tanks of freezing water for up to three hours. After subjects were frozen, they then underwent different methods for rewarming. Many subjects died in this process (Jewish Virtual Library).

Another study placed prisoners naked in the open air for several hours with temperatures as low as −6 °C (21 °F). Besides studying the physical effects of cold exposure, the experimenters also assessed different methods of rewarming survivors (Bogod 2004). "One assistant later testified that some victims were thrown into boiling water for rewarming" (Berger 1990).

The freezing/hypothermia experiments were conducted for the Nazi high command to simulate the conditions the armies suffered on the Eastern Front, as the German forces were ill-prepared for the cold weather they encountered. Many experiments were conducted on captured Russian troops; the Nazis wondered whether their genetics gave them superior resistance to cold. The principal locales were Dachau concentration camp and Auschwitz. Sigmund Rascher, an SS doctor based at Dachau, reported directly to Reichsführer-SS Heinrich Himmler and publicized the results of his freezing experiments at the 1942 medical conference entitled "Medical Problems Arising from Sea and Winter" (Tyson 2000). In a letter from September 10, 1942, Rascher describes an experiment on intense cooling performed in Dachau where people were dressed in fighter pilot uniforms and submerged in freezing water. Rascher had some of the victims completely underwater and others only submerged up to the head (Jewish Virtual Library).

"Exitus" (death) table compiled by Sigmund Rascher (Distel 2005).

Attempt no.	Water temperature	Body temperature when removed from the water	Body temperature at death	Time in water	Time of death
5	5.2 °C (41.4 °F)	27.7 °C (81.9 °F)	27.7 °C (81.9 °F)	66'	66'
13	6 °C (43 °F)	29.2 °C (84.6 °F)	29.2 °C (84.6 °F)	80'	87'
14	4 °C (39 °F)	27.8 °C (82.0 °F)	27.5 °C (81.5 °F)	95'
16	4 °C (39 °F)	28.7 °C (83.7 °F)	26 °C (79 °F)	60'	74'
23	4.5 °C (40.1 °F)	27.8 °C (82.0 °F)	25.7 °C (78.3 °F)	57'	65'
25	4.6 °C (40.3 °F)	27.8 °C (82.0 °F)	26.6 °C (79.9 °F)	51'	65'
	4.2 °C (39.6 °F)	26.7 °C (80.1 °F)	25.9 °C (78.6 °F)	53'	53'

Malaria experiments

From about February 1942 to about April 1945, experiments were conducted at the Dachau concentration camp in order to investigate immunization for treatment of malaria. Healthy inmates were infected by mosquitoes or by injections of extracts of the mucous glands of female mosquitoes. After contracting the disease, the subjects were treated with various drugs to test their relative efficacy. Over 1,000 involuntary subjects were included in these experiments, with many dying and others suffering severe pain and disability (Annas and Grodin 1992; Truscott and Cheever 1946).

Immunization experiments

At the German concentration camps of Sachsenhausen, Dachau, Natzweiler, Buchenwald, and Neuengamme, scientists tested immunization compounds and serums for the prevention and treatment of contagious diseases, including malaria, typhus, tuberculosis, typhoid fever, yellow fever, and infectious hepatitis (Metzger et al. 2019; United States Holocaust Memorial Museum 2006).

Epidemic jaundice

From June 1943 until January 1945 at the concentration camps Sachsenhausen and Natzweiler, experimentation with epidemic jaundice was conducted. The test subjects were injected with the disease in order to discover new inoculations for the condition. These tests were conducted for the benefit of the German Armed Forces. Most subjects died in the experiments, while others experienced great pain and suffering (Jewish Virtual Library 2).

Mustard gas experiments

At various times between September 1939 and April 1945, many experiments were conducted at Sachsenhausen, Natzweiler, and other concentration camps to investigate the most effective treatment of wounds caused by mustard gas. Test subjects were deliberately exposed to mustard gas and other vesicants (blister agents: highly reactive chemicals that react with cells and cellular components and cause severe skin, eye and mucosal pain and irritation), which inflicted severe chemical burns. The victims' wounds were then tested to find the most effective treatment for the mustard gas burns.

Rudolf Emil H. Brandt (1909-1948) was a German SS office who was the personal administrative officer to Reichsführer-SS Heinrich Himmler. At the Doctor's Trial at Nuremberg he provided an affidavit concerning the poison gas experiments at Sachsenhausen and Natzweiler. Among statements in his affidavit were the following (Brandt 1946):

• Late in 1939 experiments were performed on involuntary human subjects at the Sachsenhausen Concentration camp to determine the effectiveness of various treatments upon wounds caused by Lost gas. Lost is a poisonous gas which has a deleterious effect on the skin. I think it is commonly known as mustard gas.
• As I understood it, the procedure followed was that wounds were crested on various parts of the body of the experimental subject and then the wound was infected with Lost.
• The experiments on human beings with Lost gas continued during 1943 and 1944 and at Sachsenhausen Concentration camp as well as Natzweiler. Some of the prisoners died as a result.
• In March 1944, the Fuehrer ordered SS Brigaderfuehrer Dr. Karl Brandt ... to further medical research in terms of gas warfare. A copy of this order was sent by Brandt to Himmler and he was asked to circulate it to the appropriate persons in the SS... I distributed copies of the Fuehrer Order...
• Prisoners used for the Lost experiments, as also with other experiments, were frequently non-German nationals. Poles and Russians were often used, as well as Gypsies and Jews. As a matter of fact, Himmler's racial policies required the use of non-Germanic persons except in some few instances where very serious political or criminal acts had been committed. Some of the prisoners died as a result of the Lost experiments during 1944.

Brandt was convicted of war crimes and crimes against humanity and executed in 1948.

Child victims of Nazi experimentation show incisions where axillary lymph nodes had been surgically removed after they were deliberately infected with tuberculosis at Neuengamme concentration camp. They were later murdered.

Sulfonamide experiments

From about July 1942 to about September 1943, experiments to investigate the effectiveness of sulfonamide, a synthetic antimicrobial agent, were conducted at Ravensbrück (Schaefer 2004). Wounds inflicted on the subjects were infected with bacteria such as [treptococcus, Clostridium perfringens (a major causative agent in gas gangrene), and Clostridium tetani, the causative agent in tetanus (Spitz 2005). Circulation of blood was interrupted by tying off blood vessels at both ends of the wound to create a condition similar to that of a battlefield wound. Researchers also aggravated the subjects' infections by forcing wood shavings and ground glass into their wounds. The infection was treated with sulfonamide and other drugs to determine their effectiveness.

Sea water experiments

From about July 1944 to about September 1944, experiments were conducted at the Dachau concentration camp to study various methods of making sea water drinkable. These victims were subject to deprivation of all food and only given filtered sea water (Jewish Virtual Library 3). At one point, a group of roughly 90 Roma were deprived of food and given nothing but sea water to drink by Hans Eppinger, leaving them gravely injured (Tyson 2000). They were so dehydrated that others observed them licking freshly mopped floors in an attempt to get drinkable water (Cohen 1990).

A Holocaust survivor named Joseph Tschofenig wrote a statement on these seawater experiments at Dachau. Tschofenig explained how while working at the medical experimentation stations he gained insight into some of the experiments that were performed on prisoners, namely those in which they were forced to drink salt water. Tschofenig also described how victims of the experiments had trouble eating and would desperately seek out any source of water including old floor rags. Tschofenig was responsible for using the X-ray machine in the infirmary and describes how even though he had insight into what was going on he was powerless to stop it. He gives the example of a patient in the infirmary who was sent to the gas chambers by Sigmund Rascher simply because he witnessed one of the high altitude/low-pressure experiments (Tschofenig 1946).

Sterilization and fertility experiments

The Law for the Prevention of Hereditarily Diseased Offspring (German: Gesetz zur Verhütung erbkranken Nachwuchses) was passed on July 14, 1933. This law legalized the involuntary sterilization of persons with diseases claimed to be hereditary: weak-mindedness, schizophrenia, alcohol abuse, insanity, blindness, deafness, and physical deformities. The law was used to encourage growth of the Aryan race through the sterilization of persons who fell with the category of genetically defective (Gardella 1999). One percent of citizens between the age of 17 to 24 had been sterilized within two years of the law passing. Within four years, 300,000 patients had been sterilized (Dahl 2001).

From about March 1941 to about January 1945, forced sterilization experiments were conducted at Auschwitz, Ravensbrück, and other places by Carl Clauberg. The purpose of these experiments was to develop a method of sterilization which would be suitable for sterilizing millions of people with a minimum of time and effort. The targets for sterilization included Jewish and Roma populations and Russian prisoners. These experiments were conducted by means of X-ray, surgery, and various drugs (Spitz 2005). Thousands of victims were sterilized. Aside from its experimentation, the Nazi government sterilized around 400,000 people as part of its compulsory sterilization program (Piotrowski 2000).

Carl Clauberg was the leading research developer in the search for cost effective and efficient means of mass sterilization. He was particularly interested in experimenting on women from age twenty to forty who had already given birth. Prior to any experiments, Clauberg x-rayed women to make sure that there was no obstruction to their ovaries. Next, over the course of three to five sessions, he injected the women's cervixes with the goal of blocking their fallopian tubes. The women who stood against him and his experiments or were deemed as unfit test subjects were sent to be killed in the gas chambers (Lifton 2017).

Experiments with poison

Somewhere between December 1943 and October 1944, experiments were conducted at Buchenwald concentration camp to investigate the effect of various poisons. The poisons were secretly administered to experimental subjects in their food. The victims died as a result of the poison or were killed immediately in order to permit autopsies. In September 1944, experimental subjects were shot with poisonous bullets, suffered torture, and often died (Spitz 2005). Some male Jewish prisoners had poisonous substances scrubbed or injected into their skin, causing boils filled with black fluid to form. These experiments were heavily documented as well as photographed by the Nazis (Lifton 2017).

Incendiary bomb experiments

From around November 1943 to around January 1944, experiments were conducted at Buchenwald to test the effect of various pharmaceutical preparations on phosphorus burns. These burns were inflicted on prisoners using phosphorus material extracted from incendiary bombs. After applying phosphorus to wounds, the phosphorus was ignited; it was allowed to burn for up to sixty-eight seconds before extinguishing the flames (Spitz 2005).

High altitude experiments

A victim loses consciousness during a depressurization experiment at Dachau concentration camp by Luftwaffe doctor Sigmund Rascher, 1942

In early 1942, prisoners at Dachau concentration camp were used by Sigmund Rascher in experiments to aid German pilots who had to eject at high altitudes. A low-pressure chamber containing these prisoners was used to simulate conditions at altitudes of up to 68,000 feet (21,000 m) (Jewish Virtual Library 4). It was rumored that Rascher performed vivisections on the brains of victims who survived the initial experiment (Cockburn 1998). Of the 200 subjects, 80 died outright, and the others were murdered (Tyson 2008). In a letter from Heinrich Himmler to Rascher on April 13, 1942, Himmler ordered Rascher to continue the high altitude experiments and to continue experimenting on prisoners condemned to death and to "determine whether these men could be recalled to life." If a victim could be successfully resuscitated, Himmler ordered that he be pardoned to "concentration camp for life" (Himmler 1942).

Blood coagulation experiments

Sigmund Rascher experimented with the effects of Polygal, a substance made from beet and apple pectin, which aided blood clotting. He predicted that the preventive use of Polygal tablets would reduce bleeding from gunshot wounds sustained during combat or surgery. Subjects were given a Polygal tablet, shot through the neck or chest, or had their limbs amputated without anesthesia. Rascher published an article on his experience of using Polygal, without detailing the nature of the human trials, and set up a company staffed by prisoners to manufacture the substance (Michalczyk 1994).

Bruno Weber was the head of the Hygienic Institution at Block 10 in Auschwitz and injected his subjects with blood types that were differed from their own. This caused the blood cells to congeal, and the blood was studied. When the Nazis removed blood from someone, they often entered a major artery, causing the subject to die of major blood loss (Lifton 2017).

Electroshock experiments

Some female prisoners of Block 10, a cellblock at the Auschwitz concentration camp where men and women were used as experimental subjects for German doctors, were also subject to electroshock therapy. These women were often sick and underwent this experimentation before being sent to the gas chambers and killed (Lifton 2017).

Other experiments

Joseph Mengele's eye experiments included attempts to change the eye color by injecting chemicals into the eyes of living subjects, and he killed people with heterochromatic eyes so that the eyes could be removed and sent to Berlin for study (Lifton 1986).

Mengele's experiments on dwarfs and people with physical abnormalities included taking physical measurements, drawing blood, extracting healthy teeth, and treatment with unnecessary drugs and X-rays (Astor 1985). Many of his victims were dispatched to the gas chambers after about two weeks, and their skeletons were sent to Berlin for further analysis (Lifton 1986).

Mengele sought out pregnant women, on whom he would perform experiments before sending them to the gas chambers (Brozan 1982).

Alex Dekel, a survivor, reports witnessing Mengele performing vivisection without anesthesia, removing hearts and stomachs of victims (Lee 1996). Yitzhak Ganon, another survivor, reported in 2009 how Mengele removed his kidney without anesthesia. He was forced to return to work without painkillers (Schult 2009).

Standards of ethics relative to German medical research: pre- and post-

Jadwiga Dzido shows scars on her leg from medical experiments to the Doctors' Trial

Ethical standards of German medical research pre-Nazi human experimentation

One of the abuses relative to Nazi human experimentation is violation of a subject's right to informed consent. Informed consent, as used in human subject research (or healthcare), refers to an active decision of a subject/patient to agree to a certain action (participate as a subject in research, receive a medical treatment, etc.) on the basis of having sufficient knowledge to understand the implications of such a decision. Informed consent assumes that the person has full autonomy to be able to agree or decline, is presented adequate information about what is involved, and has the ability to understand what is presented.

After World War II, when those responsible for the above-noted horrific crimes were brought to justice in the Doctors' Trial component of the Nuremberg Trials, some of the Nazi doctors defended themselves by claiming that at the time of their experiments there were no explicit regulations in Germany governing medical research on human beings (Vollmann and Winau 1996).

However, as noted by Vollman and Winau (1996), there were ethical guidelines for medical research established at least as early as the nineteenth century in Germany, including explicit statements regarding informed consent. The authors note that as early as 1891, the Prussian minister of the interior issued a directive dealing with voluntary consent in terms of the use of tuberculin for treatment of tuberculosis in prisons, stating it "must in no case be used against the patient's will." But the authors note in particular the important developments in research ethics and informed consent related to the Neisser case, which led to the "first detailed regulations about non-therapeutic research in Western medicine."

The Neisser case involved clinical trials conducted by Albert Neisser. His research involved injecting cell-free serum from patients with syphilis into patients admitted for other medical issues, hoping this might act as a vaccination against syphilis. None of the subjects were informed about the experiments or were asked for consent. Some of the subjects subsequently contracted syphilis, although Nessler argued that because most of his patients were prostitutes, they probably contracted the disease independent of his serum injections. In 1898, Albert Neisser published the results of his clinical trials on serum therapy (Vollmann and Winau 1996).

The Neisser case led to public, legal, and legislative concern. An important figure in bringing Neisser's work to public attention was Albert Moll, a private-practice psychiatrist in Berlin. In his Physicians' Ethics, Moll had presented 600 cases of what he considered unethical, non-therapeutic research on humans, in which he emphasized the need for informed consent. Moll considered Neisser's work to be another example of unethical research. A public prosecutor investigated the case in 1898 as well, and Neisser was fined by the Royal Disciplinary Court, which according to the summary of Vollmann and Winau (1996), found that "though Neisser as a well known medical authority may have been convinced that the trials were harmless, he should have sought the patients' consent." The authors reiterated that it was "not questionable science but lack of patients' consent" that "was the main principle for the legal judgment."

Based on the Neisser case, and a request from the Prussian parliament, the minister for religious, educational, and medical affairs asked for a report from the Scientific Medical Office of Health, which concluded, as summarized by Vollmann and Winau (1996), "a physician who recognised that an injected serum might cause infection had no right to inject such a serum. In any case, both informing the subject and obtaining the subject's consent were preconditions to experimentation." The minister further sought legal advise from lawyers, who advised, again summarized by Vollmann and Winau (1996), that "conducting non-therapeutic research on a subject without consent fulfilled the criteria for causing physical injury in criminal law. The scientific validity of the experiment did not serve as mitigation. Informed consent was a mandatory precondition for any non-therapeutic research."

On this basis, the minister for religious, educational, and medical affairs issued, in 1900, a directive to all hospitals and clinics. According to Vollman and Winau (1996), this directive required that "all medical interventions other than for diagnosis, healing, and immunization were excluded under all circumstances if 'the human subject was a minor or not competent for other reasons' or if the subject had not given his or her 'unambiguous consent' after a 'proper explanation of the possible negative consequences' of the intervention." The directive was not, however, legally binding.

Criticism of unethical human subject research by parliament and the press, coupled with political reform of criminal law, led the Reich minister of the interior to issue, in 1931, detailed "guidelines for new therapy and human experimentation," regulating both therapeutic and non-therapeutic research in human subjects (Vollmann and Winau 1996)). This Reich Circular on Human Experimentation of February 28, 1931, included such regulations as the following (Weindling 2011; Vollman and Winau 1996):

• Experimentation involving children or young persons under 18 years of age shall be prohibited if it in any ways endangers the child or young person
• Innovative therapy may be carried out only after the subject or his legal representative has unambiguously consented to the procedure in light of relevant information provided in advance
• New therapy may be applied only if consent or proxy consent has been given in a clear and undebatable manner following appropriate information.
• New therapy may be introduced without consent only if it is urgently required and cannot be postponed because of the need to save life or prevent severe damage to health.
• [Non-therapeutic research was] under no circumstances permissible without consent.

Based on the 1931 Circular, Vollman and Winau note: "For the first time in history informed consent, the research process, and explicit clarification of personal responsibility for the experiment were required to be included in the medical record."

Based on their review of German policy, Vollman and Winau (1996) concluded the following:

• Explicit directives concerned with the welfare of people subjected to medical experimentation in Germany were in place long before the Nuremberg code was devised in 1947.
• We conclude that at the turn of the century informed consent was already a legal doctrine in medical experimentation in Germany, being based on "unambiguous consent" of the subject after "proper" information had been given by the doctor, including negative consequences and side effects.
• Our primary objective was to show that the basic concept of informed consent was developed long before the second world war and before Nazi crimes in Germany, not on the initiative of the medical profession or research community but as a legal doctrine by government authorities. The guidelines of 1931 were not annulled in Nazi Germany, when unethical experiments were performed by German doctors in concentration camps.

Nuremberg Code

The Nuremberg Code was a landmark document that arose as a result of the portion of the Nuremberg Trials dealing with the atrocities of the human experiments conducted by Nazi physicians (the "Doctors' Trial") and delineates ten ethical principles for research with human subjects. The ten principles were introduced in the judges' verdict of August 19, 1947, in a section titled Permissible Medical Experiments. Following the presentation of the ten principles, the judges' verdict concludes with statements about the legal nature of the principles" and then notes observed violations of these ten principles by the defendants:

In every single instance appearing in the record, subjects were used who did not consent in the experiments; indeed, as to some of the experiments, it is not even contended by the defendants that the subjects occupied the status of volunteers. In no case was the experimental subject at liberty of his own choice to withdraw from any experiment. In many cases experiments were performed by unqualified persons; were conducted at random for no adequate scientific reason, and under revolting physical conditions. All of the experiments were conducted with unnecessary suffering and injury and but very little, if any, precautions were taken to protect or safeguard the human subjects from the possibilities of injury, disability, or death. In every one of the experiments the subjects experienced extreme pain or torture, and in most of them they suffered permanent injury, mutilation, or death, either as a direct result of the experiments or because of lack of adequate follow-up care.

The Nuremberg Code was developed to identify basic ethical principles of research with human subjects and to address the arguments of the defendants that there were no explicit rules governing research with human subjects; that their research differed little from those conducted by American and German researchers in the past; and there was no international law or even formal statements that made clear the difference between legal and illegal experimentation. For this reason, there was a need for the prosecution to demonstrate how the defendants' experiments had deviated from fundamental ethical principles that should govern research in civilized society. Two doctors who were working with the prosecution during the trial, Dr. Andrew Ivy and Dr. Leo Alexander, drew up six points delineating legitimate research principles, and they submitted this memorandum on April 17, 1947, to the U.S. Counsel for War Crimes. When the August 19, 1947, verdict was issued, these six points had been revised into ten points and issued as part of the verdict. These ten points became known as the Nuremberg Code (United States Holocaust Memorial Museum).

Arising from the horrifying experiments conducted on people by Nazi researchers, the value of the Nuremberg Code outside of that particular sphere was not initially appreciated. However, it did become the source for subsequent, widely recognized ethical codes, such as the Declaration of Helsinki and the Common Rule.

Modern ethical issue: Use of the data from the experiments

"I don't want to have to use the Nazi data, but there is no other and will be no other in an ethical world ... not to use it would be equally bad. I'm trying to make something constructive out of it." —Dr John Hayward, justifying citing the Dachau freezing experiments in his research (Cohen 1990).

A current issue is the ethics of using the Nazi experimental data.

Andrew Conway Ivy stated the Nazi experiments were of no medical value (Berger 1990). Data obtained from the experiments, however, has been used and considered for use in multiple fields, often causing controversy. Some object to the data's use purely on ethical grounds, disagreeing with the methods used to obtain it, while others have rejected the research only on scientific grounds, criticizing methodological inconsistencies (Berger 1990). Those in favor of using the data argue that if it has practical value to save lives, it would be equally unethical not to use it (Cohen 1990). Arnold S. Relman, editor of The New England Journal of Medicine from 1977 till 1991, refused to allow the journal to publish any article that cited the Nazi experiments (Berger 1990).

The results of the Dachau freezing experiments have been used in some late twentieth century research into the treatment of hypothermia; at least 45 publications had referenced the experiments as of 1984, though the majority of publications in the field did not cite the research (Berger 1990). Those who have argued in favor of using the research include Robert Pozos from the University of Minnesota and John Hayward from the University of Victoria (Cohen 1990). In a 1990 review of the Dachau experiments, Robert Berger concludes that the study has "all the ingredients of a scientific fraud" and that the data "cannot advance science or save human lives" (Berger 1990).

In 1989, the United States Environmental Protection Agency (EPA) considered using data from Nazi research into the effects of phosgene gas, believing the data could help US soldiers stationed in the Persian Gulf at the time. They eventually decided against using it, on the grounds it would lead to criticism and similar data could be obtained from later studies on animals. Writing for Jewish Law, Baruch Cohen (1990) concluded that the EPA's "knee-jerk reaction" to reject the data's use was "typical, but unprofessional," arguing that it could have saved lives.

Controversy has also risen from the use of results of biological warfare testing done by the Imperial Japanese Army's Unit 731. The results from Unit 731 were kept classified by the United States until the majority of doctors involved were given pardons (Reilly et al. 2003).

See also

• Belmont Report
• Common Rule
• Declaration of Helsinki
• Doctors' Trial
• Human subject research
• Informed consent
• Nuremberg Code
• Unit 731

References

ISBN links support NWE through referral fees

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