The revelations at Nuremberg were extremely discomforting to the American medical establishment: the sheer unprecedented scale of immorality of the Nazi doctors was staggering — and the potential of guilt by association. The fact that the American medical profession had also enthusiastically embraced eugenics; Americans provided financial support for Nazi racial hygiene research; they adopted Germany’s medical education model and research methodology; American physicians supported and participated in forced sterilizations. Several Nazi doctors tried at the Nuremberg Doctors Trial cited unethical experiments that were conducted by American doctors.
Some American psychiatrists even entertained medical murder of “defective” children at the same time that the Nazi doctors were mass murdering children and adult patients whose lives were deemed “not worth living.”
In 1942, at the annual meeting of the American Psychiatric Association, psychiatrist Foster Kennedy, president of the American Euthanasia Society, advocated killing “feebleminded” “defective” children and adults whom he called “Nature’s mistakes,” “hopeless ones who should never have been born.” (Jay Joseph. The Missing Gene, 2007) An anonymous editorial in the American Journal of Psychiatry sided with Kennedy, and even advocated for “enabling legislation” to facilitate the process legally. No one at the APA expressed the opinion that it would be unethical to kill disabled individuals (Rael Strous. Psychiatry During the Nazi Era, 2007).
In an article in the New England Journal of Medicine (1949), Dr. Alexander wrote:
American physicians are still far from the point of thinking of killing centers, but they have arrived at a danger point of thinking, at which likelihood of full rehabilitation is considered a factor that should determine the amount of time, effort and cost to be devoted to a particular type of patient. . . . Americans should remember that the enormity of a euthanasia movement is present in their own midst. (L. Alexander. NEJM, 1949)
The consequent failure to develop meaningful standards of research ethics, independent peer review of the ethics of protocols, and the enactment of enforcement mechanisms with sever professional sanctions and criminal penalties for violations of ethical standards has been costly both to medicine and to generations of research subjects who have suffered harm. Most of the scandals that have subsequently occurred — as documented in this Chronology — and continue to occur in the United States could have been prevented, and likely would have been prevented, had Nuremberg’s lessons been acknowledged and internalized.
“The path to the Holocaust came into a clearer focus, and with it, the recognition of the multiple components of that path, which are still present in contemporary medicine and culture. I am now inclined to think that the future might well be scarier than the past, in view of the evolving sophistication of medical sciences and technologies, and the ease with which they can be camouflaged as progress, especially when unaccompanied by a maturation of our collective and individual souls. Because societal blindness may usher in unimaginable adverse consequences of unprecedented proportions, the call to ethical responsibility is now broader and more important than perhaps at any time in the past.” (Mauro Ferrari. No Exceptions, No Excuses: A Testimonial in Human Subjects Research after the Holocaust, 2014)
The revelations at Nuremberg were extremely discomforting to the American medical establishment: the sheer unprecedented scale of immorality of the Nazi doctors was staggering — and the potential of guilt by association. The fact that the American medical profession had also enthusiastically embraced eugenics; American physicians had conducted unethical experiments that were cited by several Nazi doctors in their defense at the Nuremberg Doctors Trial; American physicians supported and participated in forced sterilizations; and some American physicians even entertained medical murder.
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