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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.

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