Fifty years ago this summer, the trial of 23 Nazi doctors and medical scientists for performing cruel and inhuman experiments on concentration-camp inmates led to the creation of the Nuremberg Code, a milestone in the history of medical ethics. The first line of the code, "The voluntary consent of the human subject is absolutely essential," is generally regarded as the sine qua non for the ethical conduct of research. During the past year, institutions throughout the United States and Europe have been sponsoring events to celebrate the Nuremberg Code as a bulwark of human decency in the pursuit of scientific knowledge.

Although the ideals it embodies are now viewed as unassailable, the code was initially greeted by medical scientists as poorly conceived and unrealistic. For decades, it only sporadically influenced research ethics in policy or in practice; many doctors and scientists resisted applying the principle of informed consent to their own work. The code's uneven influence can be attributed to the extreme circumstances of its origin, the culture of medicine at the time, and the broad phrasing its authors employed. Like so many ethical maxims ("Love thy neighbor as thyself"), the principle of voluntary informed consent seems uncomplicated. Yet 50 years after it was first articulated, we are still struggling to live up to it.

To Do More Than Hand Down Judgments

The war crimes trial of the Nazi doctors that led to the code was held in Nuremberg, West Germany, from December 1946 to August 1947. Nuremberg was chosen partly for symbolic reasons, for it was there that the Nazi Party held giant, theatrical rallies designed both to impress those faithful to the Reich and to intimidate those who opposed it.

The doctors' trial began a few months after the conclusion of proceedings against two dozen leaders of the Third Reich, including Hermann Goering, Rudolf Hess, and Joachim von Ribbentrop. Although the American forces occupying Germany had not at first planned to conduct an inquest on human experimentation, their decision changed as information emerged about the medical atrocities committed in the concentration camps. The details of what prosecutors called "the medical case" so shocked them that they decided to pursue the matter as a war crime under the charter of the international tribunal.

Medicine had a central place in the Nazi enterprise, for the Nazis believed doctors had a special role in improving the "Volk." Jews, Gypsies, homosexuals, the mentally retarded, and others were singled out as corrupting influences in the German national body, much like bacteria invading the individual. The view that these groups constituted a kind of public health menace implied an instrumental role for the medical profession in the business of "diagnosing" and "treating" the problem.

Although many doctors were involved in the Nazis' racial hygiene policies-and nearly half of German doctors were Nazi party members-those who had access to concentration camp inmates for research purposes had to be well connected with the Nazi political hierarchy. Although we are not accustomed to thinking of the Nazi doctors in the mundane terms of careerism, part of their motivation was typical academic ambition. These scientists wanted to be among the first to make the medical breakthroughs that would advance the military goals of the Third Reich and make them heroes of racial medicine.