601px-karl-brandt
Photo of Karl Brandt, personal physician to Hitler, active in SS, Commissioner for Health and Sanitation. After WWII, he was tried at Nuremberg and found guilty of war crimes, crimes against humanity, and membership of a criminal organization. He was executed by hanging in 1948.

Objectives:

  1. Review Nuremberg Code
  2. Explore hypothetical situation concerning unethical medical experimentation
  3. Briefly discuss real-life Nazi medical experimentation
  4. Discuss perspectives on what to do with unethically obtained data

The Nuremberg Code came about after the 1947 Nuremberg “Doctors’ Trial” in which several Nazi physicians who performed cruel experiments on unwitting human subjects were tried. The Nuremberg Code comprises 10 directives for human experimentation and is still relevant today.

Nuremberg Code, briefly stated:

  1. Obtain voluntary consent of all human subjects
  2. Perform experiments that will benefit society and are not unnecessary
  3. Expect that the results will give good reason for the experiment
  4. Avoid suffering by or injury to the subjects
  5. Do not perform experiment if there is any belief that death or disabling injury will occur
  6. Make sure the risk taken by the subject does not surpass the importance of the results of the experiment
  7. Protect the subjects from injury or death
  8. Ensure that only “scientifically qualified persons” are performing the experiments
  9. Cease the experiment if the subject feels physically or mentally pushed to the limit
  10. Expect that lead scientist will call the experiment to an end if he or she believes there is a danger to the subject

These directives for human experimentation seem simple and reasonable. However, misguided researchers have, in the past, and may, in the future, stray from these guidelines. The question, then, is what do we do with data gleaned from unethical experimentation? Especially if the data are valuable to the health and well-being of our patients.

This is a very difficult question to tackle. In order to tackle this question, I will employ a technique that has been employed by teachers since Socrates. We will explore a hypothetical situation that deals with the topic at hand.

Although our particular hypothetical situation is from popular culture, it is not meant to trivialize the issue. Rather, this hypothetical is meant as a vehicle for serious thought and exploration. Our hypothetical situation comes from the television show Star Trek: Voyager, episode 8 from season 5 entitled “Nothing Human.”

Here is a brief summary of the episode: The ship’s chief engineer Lt. B’Elanna Torres finds herself in a situation in which an alien being has attached itself to her, piercing her vital organs, in an attempt to keep itself alive while sapping the life from her. Lt. Torres will die if the alien is not removed properly. Unfortunately, the ship’s holographic doctor has no idea how to remove the alien and save B’Elanna’s life. The doctor says he needs to consult an expert in alien biology, an exobiologist. A  plan is construed to create a hologram of Dr. Crell Moset, a Cardassian physician who is a leader in the field of exobiology.

Dr. Crell Moset also cured the fictional, but deadly, fostossa virus. The fact that Dr. Crell Moset is of a race called the Cardassians is of some consequence, especially to a crew member whose planet was occupied by the Cardassians during ‘the war.’ When that crew member expresses concern, the ship’s doctor states that he doesn’t care if Moset was the “nastiest man who ever lived,” as long as he can help save Torres’ life.

A conflict arises when Ensign Tabor, the Bajoran officer whose planet was occupied by the Cardassians, recognizes Dr. Moset. He is horrified, explaining:

“I can still remember the sounds his instruments made; the screams of his patients; the smell of chemicals and dead flesh. He operated on my grandfather, exposed his internal organs to nadion radiation. It took six days for him to die.”

The following conversation between Ensign Tabor and the Doctor reveals the more about Crell Moset’s experimentation on unwitting subjects:

Ensign Tabor: He blinded people so he could study how they adapted; exposed them to polytrinic acid just to see how long it would take for their skin to heal!

Doctor: Ensign, the man you’re accusing cured the fostossa virus. He stopped an epidemic that killed thousands of Bajorans!

Ensign: By infecting hundreds of people. So that he could experiment with different treatments; old, helpless people, like my grandfather, because he considered their lives worthless!

Doctor: How do you know this?

Ensign: Everybody knew.

So, although yielding useful results, Dr. Moset employed unethical methods in his research. The dilemma we are faced with is now two-fold:

  1. Is it moral to use Dr. Moset’s knowledge, which was gained through the blood of innocents, to help save a crew member’s life?
  2. Would using the knowledge set a dangerous precedent for the future, thereby condoning such cruel research methods?

Ensign Tabor, after learning that Dr. Moset enjoys a position as the chair of exobiology at a university, offers this as a solution to the aforementioned dilemma:

“We may not be able to do anything about the real Moset, Commander, but the program should be destroyed. Every trace of that man’s research should be deleted from the database.”

The commanding officers also struggle with the dilemma:

Tuvok: If the Doctor uses knowledge that Moset gained through his experiments, we would be validating his methods, inviting further unethical research.

Chakotay: We’d be setting a terrible precedent.

Paris: We’re in the middle of the Delta Quadrant, who would know?

Tuvok: We would know.

Paris: Fine. Let’s just deactivate the evil hologram and let B’Elanna die. At least we’d have our morals intact.

It is interesting to note that Tuvok, who is a Vulcan (an exemplar of logical thinking) posits that validating the methods of an unethical researcher may invite further unethical research.

For the captain of the ship, there is no question that Lt. Torres’ life should be saved, so she orders it done. But, a question still persists: what should be done with the file containing the information from Moset’s research after the current situation is resolved? Should it be deleted? Or, should it be kept for future medical emergencies?

Unfortunately, such a situation is not merely a hypothetical. The Nazis performed many gruesome and inhumane medical experiments on inhabitants of concentration camps. Before we find out how the characters in our hypothetical situation resolve this ethical dilemma, I would like to briefly explore some of types of Nazi experiments that took place on human subjects.

The experiments included freezing experiments in which inmates were submerged in tanks of ice water and left to shiver to death to see how long a human could survive in freezing waters. There were also high altitude experiments in which subjects were put in decompression chambers to simulate high altitudes, then their living brains were dissected to see the air bubbles that would form in subarachnoid vessels. Additionally, one can find sulfanilamide experiments in which wounds were inflicted on prisoners and infected with bacteria, then treated with the new drug (sulfanilamide) to see how well it would work to fight the infections. There were sterilization experiments and artificial insemination experiments. And Tuberculosis experiments in which axillary lymph glands were removed from Jewish children to see if there were natural immunities to the disease from which a vaccine could be developed.

Nothing Human?

Surprisingly, or perhaps not so for some, many modern scientific journal articles cite the data produced in these experiments. One of the authors of the book Hypothermia Frostbite and other Cold Injuries uses Nazi data in his research. Also, the survival suit, which you may have seen on the TV show “The Deadliest Catch,” the suit that allows people to survive in freezing cold waters, came about as a result of using Nazi data.

Let us take into consideration the following quote from Kristine Moe from the essay “Should the Nazi Research Data be Cited?”: “Nor, however, should we let the inhumanity of such experiments blind us to the possibility that some ‘good’ may be salvaged from the ashes.” We are left puzzling about what to do with this data gleaned with unethical medical experimentation. If we use it, is it setting a terrible precedent for the future? If we don’t use it, are we just letting bad things happen without salvaging any good from it?

We do have this question: What should the medical community do with data from research that was performed in a way that did not respect the rights of human beings as was the fas with Nazi human experimentation?

The holographic doctor in our hypothetical situation also struggles with this dilemma:

Doctor (to holographic Moset): Your program, despite all it’s brilliance, is based on his work. He infected patients, exposed them to polytrinic acid, mutilated their living bodies. And now we’re reaping the benefits of those experiments. Medically, ethically, it’s wrong.

Moset: What do you suggest we do about it?

Doctor: I’m not sure. We may have to delete your program.

Moset’s holographic image then argues that such is the price one pays to further medical science. He then makes the point that much of the medical data banks would have to be erased due to questionable ethics in research methods. And argues further the ever-popular idea that ethics are relative.

The doctor responds that sometimes the price is too high. Just because Moset cured a deadly virus that would have killed many more if gone unchecked, that does not justify inhumanely using people in his experiments. Interestingly, the decision of whether or not keep the file containing the holographic image of Dr. Crel Moset (and all of the data that goes along with that) is left up to the ship’s Doctor:

Crell Moset: You can erase my program Doctor, but you can never change the fact that you’ve already used some of my research. Where was your conscience when B’Elanna was dying on that table? Ethics, morality, conscience. Funny how they all go out the airlock when we need something. Are you and I really so different?

Doctor: Computer, delete medical consultant program and all related files.

The Doctor makes the decision to wipe the files of Moset out of the computer’s memory banks.

Opposing Views

In real life, there are opposing views of what to do with research involving unethical experimentation. Brigadier General Telford Taylor, chief counsel for the prosecution during the Nuremberg “Doctors’ Trial,” felt the wisdom gleaned from the Nazi experiments should not be utilized. In his opening statement, he asserted, “These experiments revealed nothing which civilized medicine can use.”

On the other hand, John S Hayward, from the University of Victoria in British Columbia, uses Nazi data in his research on hypothermia. He states, “I don’t want to have to use this data, but there is no other and will be no other in an ethical world.”

Still others feel that the data from inhumane experiments should only be used “in the most exceptional circumstances” and solely “in the absence of ethically derived data.”

In order to decide what the medical community should do with data from unethical human medical experimentation, we need to ask ourselves:

Is Kristine Moe right? Can some ‘good’ be salvaged from the ashes?

How does one cite the data if one is to use it?

Does one ignore where the data came from?

Or, like the Doctor from Voyager suggests when he responds to Moset’s request to publish a paper together: “A footnote, perhaps. For further details, see Cardassian death camps.”

We do not, as a community, have an answer to the question of what to do with data from unethical medical experiments. We do, however, have a moral imperative: We much make sure ethical guidelines like the Nuremberg Code are followed when experimenting with humans; we must make sure that we never again let anything like what happened during the Nazi human experiments happen again; and we must always consider the precedent that we are setting for the future.

References

https://history.nih.gov/research/downloads/nuremberg.pdf. Accessed 8/18/2016.

Cohen, B. “The Ethics of Using Medical Data From Nazi Experiments.” Jewish Virtual Library. http://www.jewishvirtuallibrary.org/jsource/Judaism/naziexp.html. Accessed 2/26/2010.

Garfield, E. Current Contents #28, p.3-13, July 15, 1985.

Moe, K. “Should the Nazi Research Data be Cited?” Hasting Center Report, December, 1984 pp. 5-7.

Garfield, E. “Citing Nazi ‘Research’: To Do So Without Condemnation is Not Defensible.” Essays of an Information Scientist: Science Reviews, Journalism Inventiveness and Other Essays, Vol 14, p. 328-9, 1991.

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