Medical Malice

To better understand how the 60-year-old trial continues to influence our lives, BU Today spoke with Annas, who is also a LAW professor of law and a professor of sociomedical sciences and community medicine at the School of Medicine, and participant Michael Grodin, an SPH professor of health law, bioethics, and human rights, clinical medical ethicist for Boston Medical Center, and cofounder with Annas of Global Lawyers and Physicians, which works to promote human rights and health.

BU Today:  What is the Nuremberg Code?
Annas: The Nuremberg Code is a judicial formulation of the legal guidelines for experimentation on human beings. It grew out of the Nuremberg Doctors Trial, which was an American trial of the Nazi doctors after World War II. It’s a 10-point code, and the most famous point is the first, which requires the informed, voluntary consent of the research subject and gives the subject the right to withdraw at any time.

Why is that relevant today? Does it have legacies that influence modern medical practice?
Annas: Yes. One legacy is that informed consent has become an absolutely essential legal and ethical guideline for both therapy and experimentation. And the doctor-patient relationship has changed markedly because of the code. Prior to Nuremberg, people argued that doctors could be trusted with the power they had. After Nuremberg, it was clear that the patient should be the one to decide who could be trusted and who had the legal right to decide to take part in research or therapy. It was also clear that it’s dangerous to let the state get involved, because the state was using doctors for its own purposes.

Grodin: The Doctors Trial was about murder, and people have tried to distance themselves from that by saying, ‘That was then and this is now, and they were Nazis and we’re not.’ But the question is, is this a difference of degree or a difference of kind? Because you can look at the litany of unethical research, like the Tuskegee syphilis trials, and many instances of physicians using people as a means to an end, and you also have physicians involved in torture.

Where are physicians involved in torture?
Grodin: Physicians are asked to participate in torture all over the world. The real goal of torture is not to kill, but to send fear into the community. So doctors are in there to legitimize and medicalize things. This has been true all over the world: in Turkey and in Cambodia. And now we have U.S. involvement of physicians in legal execution as well as what’s happening in prisons where doctors are participating in things like force-feeding at places like Guantanamo.

Why is it necessary to use doctors to torture people?
Grodin: You want doctors there because they can perfect the torture. You can learn when to stop without killing the person. The other thing is that it sterilizes the action and legitimizes it and medicalizes it. It says, ‘Doctors are involved, so it must be OK.’ Of course, physicians were involved throughout in Nazi Germany, in eugenics and sterilization and euthanasia and just plain murder. At the death camps, the doctors were the ones who decided who would live and who would die. That’s what this event is about. It’s a commemoration of the 60th anniversary of the Doctors Trial, which is a story of how doctors as agents of the state were involved in all sorts of things, including eugenics and murder. This is a major milestone in the history of the world as it relates to international law and human rights.

Annas: The discussion is also about human dignity. The reason the Nazis were able to do everything they did was because they treated the Jews and the Gypsies and everyone else as subhuman. They didn’t have human dignity. If you take human dignity away, you revert to torture and murder. You remember when [Army Major] General [Geoffrey] Miller went to Abu Ghraib, he told them, ‘I want these people treated like dogs.’ He did that to dehumanize them.

Are there also issues with genetics?
Annas: Yes. Serious issues. Like what’s the difference between clinical genetics and eugenics? What’s the difference between what the Germans wanted to do to have a pure race and what we want to do to search and destroy people with genetic conditions that we don’t find acceptable? The big question is, is it wrong for people to do privately what the government is not allowed to do?

What about painful genetic conditions?
Grodin: Painful to whom? To the people who were born with them, or painful to the people who take care of them?

Annas: These are complicated issues, and people are trying to figure out what is the right thing to do. Insurance companies would now like to have everyone believe that the right thing to do if you’re pregnant is be screened for genetic problems, and if there are any problems, then the right thing to do is have an abortion, at least if you are going to have a child with a serious condition.

Grodin: What message does that give to kids who are born with genetic conditions? We would have aborted you if only we had known?

I’m sure that someone will discuss the strange psychological process called doubling. What is doubling?
Grodin: Doubling is self-deception. It’s being one person in the camps and going home and listening to Wagner. And I will talk about it. It’s about what it takes to become a torturer. It’s the ability to split yourself into two people. I will talk about how torturers are made. Are they made or are they born? And why is it that physicians are particularly vulnerable to it?

Well, why is it?
Grodin: You’ll have to come to the talk.

The Nuremberg Doctors Trial: 60 Years Later will be held on Friday, March 30, from 8:30 a.m. to 5 p.m. at the George Sherman Union Auditorium, 775 Commonwealth Ave. The forum is free and open to the public, but advanced registration is recommended. For a conference schedule and to register, go to http://id-andrea.cms-devl.bu.edu/law/.

Art Jahnke can be reached at jahnke@bu.edu.