Nuremberg Code

纽伦堡密码
  • 文章类型: Historical Article
    在Covid-19大流行期间,伦理学家,研究人员,记者建议进行研究,故意将冠状病毒感染健康志愿者,作为加快疫苗开发的科学手段。在这篇文章中,我们追溯了感染挑战实验的历史,并反思了1947年的纽伦堡法典,该法典是针对纳粹调查人员在集中营中进行的残酷人体实验而发布的。我们认为,该准则继续为评估这种有争议的研究形式的伦理提供有价值的指导,特别是关于研究风险的可接受限制和必要的研究的社会价值,以证明将人类参与者暴露于这些风险。
    In the midst of the Covid-19 pandemic, ethicists, researchers, and journalists have recommended studies that deliberately infect healthy volunteers with the coronavirus as a scientific means of expediting vaccine development. In this essay, we trace the history of infection challenge experiments and reflect on the Nuremberg Code of 1947, issued in response to brutal human experiments conducted by Nazi investigators in concentration camps. We argue that the Code continues to offer valuable guidance for assessing the ethics of this controversial form of research, with respect particularly to the acceptable limits to research risks and the social value of research necessary to justify exposing human participants to these risks.
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  • 文章类型: Historical Article
    In 1936, the American Neurological Association (ANA) published the book \"Eugenical Sterilization: A Reorientation of the Problem\" in response to what the first author of the book described as a positive reception to a paper presented at the ANA\'s 1935 annual meeting. The conclusions of the presentation were approved by the organization during the same meeting. As evidenced by the publication of several book reviews in a variety of medical journals, the book garnered some attention.
    Reviews of the ANA\'s book were sought using PubMed, Google Scholar, and Embasa. Also, the book\'s title was used to search the World Wide Web.
    The search yielded four reviews, all published in 1937. The reviews make evident a positive opinion of the ANA\'s book\'s authors\' recommendations including the option for \"selective sterilization\" of patients with conditions such as Huntington disease, Friedreich ataxia, and epilepsy. In addition, reviewers highlighted the book\'s authors\' assessment that \"the feebleminded [breed] docile, servile, useful people who do the dirty work of the race, [as] servants fulfilling a social function.\"
    Although the book\'s authors did not advocate for all-out eugenical sterilization, they did little to counter the popular opinion that patients with certain neurological diseases were a drain on society. In addition, they espoused a positive vision of the feebleminded\'s role as servants who can do undesirable work. This message was disseminated through book reviews.
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  • 文章类型: Journal Article
    有大量已发表的证据表明,每年有无数人参加道德缺陷的临床试验。许多试验都是有问题的,因为用来证明其发射的科学质量可能没有得到充分审查,而许多其他试验可能缺乏必要的社会价值。这提出了一个问题:为什么人们自愿为他们服务?答案在很大程度上在于知情同意做法在历史上被掩盖了,而不是披露,这些信息可以提醒研究候选人注意试验的道德问题。修订后的《美国共同规则》中的“合理人”和“关键信息”条款为纠正这一历史缺陷创造了机会。使用两个来源来阐明应向“合理的人”披露的“关键信息”:《纽伦堡法典》的原始披露目标,以及大量的元研究证据。这些消息来源共同支持知情同意过程中的一系列新披露,这些披露将揭露迄今未披露的信息。由此提出的新披露涉及临床试验的整体成功前景,先前研究的质量,既是临床试验的基础,又是对其风险和收益的评估,临床试验的潜在社会价值,和临床试验的商业目的。
    There is substantial published evidence showing that countless people enroll each year in ethically deficient clinical trials. Many of the trials are problematic because the quality of the science used to justify their launch may not be sufficiently vetted while many other trials may lack requisite social value. This poses the question: why do people volunteer for them? The answer resides in large part in the fact that informed consent practices have historically masked, rather than disclosed, the information that would alert research candidates to the ethically problematic nature of the trials. The \"reasonable person\" and \"key information\" provisions in the revised US Common Rule create the opportunity to correct this historical shortcoming. Two sources are employed to shed light on what the \"key information\" is that should be disclosed to a \"reasonable person\": the original disclosure aims of the Nuremberg Code, as well as an extensive body of meta-research evidence. Those sources jointly support a range of new disclosures in the informed consent process that would unmask the heretofore undisclosed information. The resulting proposed new disclosures pertain to the overall success prospects of clinical trials, the quality of the prior research that both forms the basis of clinical trials and informs assessment of their risks and benefits, the potential social value of clinical trials, and the commercial purposes of clinical trials.
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  • 文章类型: Journal Article
    In clinical medicine, the moral obligation to care for the individual patient is absolute. Patient care means at least and by negative terms to minimize any risk of treatment. In this context, the question arises about the compatibility of clinical ethics and human biomedical research ethics. Or conversely, is there a common ground between the two? At the opposite end of the field between clinical ethics and biomedical research ethics is the proposal of an obligation to participate in biomedical research, which is argued for on the basis of biomedical knowledge being a public good available to the community as a whole. While patient accrual during a clinical investigation would certainly be facilitated by obligatory research participation, and the data obtained would be-at first sight-more representative for the population studied, the still feasible refusal to participate would be stigmatizing and as such detrimental for the patient-physician relation. This essay seeks to provide a reply to the titled question by focusing on aspects such as individual vs common medical claims, shared grounds between the two and an important document of medical research ethics, that is the Nuremberg code.
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  • 文章类型: Journal Article
    In 2010, in an article in this journal, I argued that declassified documents implicated Central Intelligence Agency (CIA) physicians in the conduct of unethical research on enhanced interrogation using detainee subjects. The focus, then as now, is upon physicians at the Office of Medical Services (OMS). The 2010 article highlighted the heavily redacted \"Draft OMS Guidelines on Medical and Psychological Support to Detainee Interrogations\" (the Draft). This commentary focuses upon the recently declassified final version of that document revealing further culpable evidence of unethical human subject research. The commentary locates that unethical research in historical context and the development of the Nuremberg Code. The commentary also locates enhanced interrogation in contemporary political context and considers how to hold OMS physicians accountable for the conduct of unethical human research using detainee subjects.
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  • 文章类型: Editorial
    In 2008 a group of former soldiers of the Israel Defense Force (IDF) sued the Ministry of Defense and others, claiming they had suffered from medical problems that resulted from an IDF medical experiment in which they had participated in the 1970s. There was no compelling medical evidence with respect to causal relationships between their participation in the experiment and their later medical problems. The President of the District Court, Justice Hila Gerstl, appointed me, with the consent of the parties, to write a deposition with respect to the ethical aspects of the case. My comments in the sequel rest on my deposition, applying not only to the case that had been under discussion but also to each and every case of experimentation. My arguments, strictly confined to the ethical aspects of the case, as opposed to the legal aspects and the debated facts, were not in favor of either party. As a result the state and the former soldiers reached an agreement approved by the court. One of the major points made in that deposition is that the Nuremberg and Helsinki principles follow from those of medical ethics in general, except for the requirement to have an Institutional Review Board (IRB). A second major point is that under very strict conditions, more than what is usually required, soldiers may participate in medical experiments administered by their military force. However, new conscripts during their first months of their service should not take part in medical experimentation within their military force.
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  • 文章类型: Comparative Study
    BACKGROUND: The aim of the study is to assess the knowledge, attitudes and practices among healthcare professionals in Barbados in relation to healthcare ethics and law in an attempt to assist in guiding their professional conduct and aid in curriculum development.
    METHODS: A self-administered structured questionnaire about knowledge of healthcare ethics, law and the role of an Ethics Committee in the healthcare system was devised, tested and distributed to all levels of staff at the Queen Elizabeth Hospital in Barbados (a tertiary care teaching hospital) during April and May 2003.
    RESULTS: The paper analyses 159 responses from doctors and nurses comprising junior doctors, consultants, staff nurses and sisters-in-charge. The frequency with which the respondents encountered ethical or legal problems varied widely from \'daily\' to \'yearly\'. 52% of senior medical staff and 20% of senior nursing staff knew little of the law pertinent to their work. 11% of the doctors did not know the contents of the Hippocratic Oath whilst a quarter of nurses did not know the Nurses Code. Nuremberg Code and Helsinki Code were known only to a few individuals. 29% of doctors and 37% of nurses had no knowledge of an existing hospital ethics committee. Physicians had a stronger opinion than nurses regarding practice of ethics such as adherence to patients\' wishes, confidentiality, paternalism, consent for procedures and treating violent/non-compliant patients (p = 0.01) CONCLUSION: The study highlights the need to identify professionals in the workforce who appear to be indifferent to ethical and legal issues, to devise means to sensitize them to these issues and appropriately training them.
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  • 文章类型: Historical Article
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  • 文章类型: Historical Article
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  • 文章类型: Comment
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